Basic Information
| Provider Information | |||||||||
| NPI: | 1932182334 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENRY-HOYT | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 737 W CHILDS AVE | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1920 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | CERES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953071827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095381096 | ||||||||
| FaxNumber: | 2095381099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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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 | NP12717 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LX0001X | AP60423171 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | MH3196498 | 01 | WA | DEA LICENSES | OTHER | AP60423171 | 01 | WA | WA STATE LICENSE | OTHER | 2047393 | 05 | WA | MEDICAID | RN 320504 | 01 | CA | RN LICENSE | OTHER | MH1230274 | 01 | CA | DEA CERT | OTHER |