Provider Demographics
NPI:1457808073
Name:MORA, SUSAN (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MORA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 DE HARO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2728
Mailing Address - Country:US
Mailing Address - Phone:415-307-1251
Mailing Address - Fax:
Practice Address - Street 1:1239 POWELL ST
Practice Address - Street 2:APT 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4874
Practice Address - Country:US
Practice Address - Phone:415-307-1251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily