Provider Demographics
NPI:1043306707
Name:WIGHT, SUSAN CALLIE (RN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CALLIE
Last Name:WIGHT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16111 PLUMMER ST
Mailing Address - Street 2:OOPW
Mailing Address - City:SEPULVEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2036
Mailing Address - Country:US
Mailing Address - Phone:818-895-9555
Mailing Address - Fax:818-895-9453
Practice Address - Street 1:16111 PLUMMER ST
Practice Address - Street 2:OOPW
Practice Address - City:SEPULVEDA
Practice Address - State:CA
Practice Address - Zip Code:91343-2036
Practice Address - Country:US
Practice Address - Phone:818-895-9555
Practice Address - Fax:818-895-9453
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 262603163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health