SUSAN BASILICATO NP NPI 1265403851

NPI Information

NPI: 1265403851
Provider Name: SUSAN BASILICATO, NP
Classification: Registered Nurse - 163WG0000X
Entity Type: Individual

Specialization: General Practice

PECOS Registration: Yes

Address:
1200 MIRA MAR AVE
MEDFORD, OR
ZIP 97504
Phone: (541) 664-5151
Get Directions

Susan Basilicato, NP is a general practice registered nurse in Medford, OR. Susan Basilicato, NP NPI is 1265403851. 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:

1200 MIRA MAR AVE
MEDFORD, OR
ZIP 97504-546
Phone: (541) 664-5151

The NPI 1265403851 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 1/31/2006 and was last updated on 11/26/2007.

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	07804146RN	OREGON	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	R114953	MEDICARE PIN	OREGON

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: 4/28/2024

NPI Synchronization or Removal

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