Susan Greenberg, GNP, RN

Primary specialty

Gerontology Registered NurseTaxonomy code 163WG0600X

License

328095 Issued in CA

Practice address

500 Petaluma Ave
Sebastopol, CA 95472-4216

Phone

(707) 326-1500

NPI assigned

Aug 24, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Susan Blackmun Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300233600000",
    "number": "1003122466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PETALUMA AVENUE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "95472",
            "telephone_number": "707-326-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PETALUMA AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724216",
            "telephone_number": "707-326-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENBERG",
        "first_name": "SUSAN",
        "credential": "GNP, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-24",
        "last_updated": "2011-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "CA",
            "license": "328095",
            "primary": true
        },
        {
            "code": "163WH1000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hospice",
            "state": "CA",
            "license": "328095",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "BLACKMUN",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Barry Seth Green, OD
• Greenacre Homes, Inc. (Greenacre Homes & School)
• Greenacre Homes, Inc. (Hurlbut)
• Greenacre Homes, Inc. (Greenacre Homes & School)
• Greenacre Homes, Inc. (Greenacre Homes and School)
• Greenbriar Emergency Physicians Medical Group, Inc.
• Lynette Grelet
• Ann-Elizabeth Griego, MD
• Growth Spurt Pediatric Therapy, Inc.
• Lora Lee Grutkowski, RN FNP-BC ACNS-BC

• Gerontology Registered Nurse in Sebastopol, CA
• Providers in Sebastopol, CA by specialty
• Gerontology Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.