SUSAN RAE AULT FNP NPI 1790777100

NPI Information

NPI: 1790777100
Provider Name: SUSAN RAE AULT, FNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
2830 EAST ST
ANDERSON, CA
ZIP 96007
Phone: (530) 365-2545
Get Directions

Susan Rae Ault, FNP is a family nurse practitioner in Anderson, CA. Susan Rae Ault, FNP NPI is 1790777100. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2830 EAST ST
ANDERSON, CA
ZIP 96007-408
Phone: (530) 365-2545
Fax: (530) 365-3871

The NPI 1790777100 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/22/2005 and was last updated on 5/31/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WG0000X	Registered Nurse	General Practice	083045668RN	OREGON	No
2	363L00000X	Nurse Practitioner		200450018NP	OREGON	No
3	364SX0200X	Clinical Nurse Specialist	Oncology	200570025CNS	OREGON	No
4	363LF0000X	Nurse Practitioner	Family	14768	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	278215	MEDICAID	OREGON
2	0577260001	MEDICARE NSC	OREGON
3	1407812365	OTHER	OREGON	GROUP NPI NUMBER
4	930635514	OTHER	OREGON	GROUP TAX ID NUMBER
5	R0000WFBTV	OTHER	OREGON	MEDICARE GROUP PIN NUMBER
6	R134534	MEDICARE PIN	OREGON
7	Q26459	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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