Derivas, Susan M
Derivas, Susan M is an sole proprietor health care provider with primary practice located at 4055 E Blueberry St , Meridian ID 83642-8261. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Derivas, Susan M can be contacted via phone (208) 775-7418.Contact Information
Primary practice address
4055 E Blueberry St
Meridian ID 83642-8261
Phone: (208) 775-7418
Fax: (208) 647-5008
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | 64266 | Idaho |
Profile Details
| NPI number | 1851493829 |
|---|---|
| LBN Legal business name | Derivas, Susan M |
| Credentials | Certified Nurse Practitioner (CNP) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 1st, 2006 |
| Last updated | Feb 7th, 2024 - about 10 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1851493829 | NPPES |
| Other | 208-775-7418 | SPRUCE HEALTH | |
| MEDICAID | 1032026 | SPRUCE HEALTH | |
| Other | 5708247 | SPRUCE HEALTH | |
| Other | 932434 | SPRUCE HEALTH | |
| Other | 0062-0104069 | SPRUCE HEALTH | |
| Other | 13961493 | SPRUCE HEALTH | |
| Other | 909072 | SPRUCE HEALTH | |
| Other | 1851493829 | SPRUCE HEALTH | |
| Other | 396453 | SPRUCE HEALTH |
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