Provider Demographics
NPI:1679805592
Name:NEWMAN, SUSAN KYLEE (RN, MSN, NNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KYLEE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:RN, MSN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 NORMAL STREET, ROOM 2121
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-725-5501
Mailing Address - Fax:
Practice Address - Street 1:4100 NORMAL ST, NURSING & WELLNESS
Practice Address - Street 2:ROOM 2121
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-725-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17798363LN0005X
CA625461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care