Provider Demographics
NPI:1730369273
Name:FIRESTONE, SUSAN P (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:P
Last Name:FIRESTONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:P
Other - Last Name:VAN HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:303 E OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-4871
Mailing Address - Country:US
Mailing Address - Phone:559-782-3901
Mailing Address - Fax:559-782-3911
Practice Address - Street 1:303 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-4871
Practice Address - Country:US
Practice Address - Phone:559-782-3901
Practice Address - Fax:559-782-3911
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 364673163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse