Individual
MRS. SUSAN I. IVANCIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN, CDE, SNIV
Contact information
Practice address
99 MONTECILLO RD, SAN RAFAEL, CA 94903-3308
(415) 444-2575
(415) 444-4622
Mailing address
99 MONTECILLO RD, SAN RAFAEL, CA 94903-3308
(415) 444-2575
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
172329
CA
Other
Enumeration date
01/30/2007
Last updated
07/08/2007
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