Provider Demographics
NPI:1679774285
Name:BASTING, SUSAN JOY
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOY
Last Name:BASTING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E LASSEN AVE
Mailing Address - Street 2:#36
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0751
Mailing Address - Country:US
Mailing Address - Phone:530-891-0822
Mailing Address - Fax:
Practice Address - Street 1:4776 SONG BIRD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-9766
Practice Address - Country:US
Practice Address - Phone:530-891-5442
Practice Address - Fax:530-892-2979
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN61415164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVNO04910OtherMEDICAL
CAEPSO16770OtherMEDICAL