Basic Information
| Provider Information | |||||||||
| NPI: | 1285676759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUGHTY | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39500 LIBERTY STREET | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102525897 | ||||||||
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| Practice Location | |||||||||
| Address1: | 39500 LIBERTY STREET | ||||||||
| Address2: | TRI CITY HEALTH CENTER | ||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107708133 | ||||||||
| FaxNumber: | 5107708140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP13911 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.