Provider Demographics
NPI:1447482187
Name:O'SULLIVAN, SUSANNA LYNN (RN, MSN, ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:LYNN
Last Name:O'SULLIVAN
Suffix:
Gender:
Credentials:RN, MSN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36101 BOB HOPE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2001
Mailing Address - Country:US
Mailing Address - Phone:248-606-7854
Mailing Address - Fax:
Practice Address - Street 1:36101 BOB HOPE DR STE 120
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2001
Practice Address - Country:US
Practice Address - Phone:760-548-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008533363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty