NPI 1265403851 · live from the CMS NPI Registry
Susan Basilicato, NP
Registered Nurse, General Practice in Medford, OR. National Provider Identifier 1265403851, active.
NPI record
| NPI | 1265403851 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Registered Nurse, General Practice 163WG0000X |
| Practice location | 1200 Mira Mar Ave, Medford, OR 97504 |
| Practice phone | 541-664-5151 |
| Mailing address | 1208 Beall Ln, Central Point, OR 97502 |
| Enumerated | January 31, 2006 |
| Last updated | November 26, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse, General Practice primary | 163WG0000X | 07804146RN (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.