Susan Basilicato, NP

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

07804146RN Issued in OR

Practice address

1200 Mira Mar Ave
Medford, OR 97504-8546

Phone

(541) 664-5151

NPI assigned

Jan 31, 2006

Last updated

Nov 26, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196035200000",
    "number": "1265403851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 BEALL LN",
            "city": "CENTRAL POINT",
            "state": "OR",
            "postal_code": "975021573",
            "telephone_number": "541-664-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MIRA MAR AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048546",
            "telephone_number": "541-664-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASILICATO",
        "first_name": "SUSAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-31",
        "last_updated": "2007-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "OR",
            "license": "07804146RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Bartow Jr., PHARMACIST
• Consuelo Bartyzal, FNP
• Heather Larena Bascom, FNP
• Baseline Laboratory Services
• Shaik Iqbal Basha, MD
• Richard Paul Baska, MS, MFT
• Peter Bass, RN
• Elizabeth Bastidas, LMT
• Eva Zhouying Batenhorst
• Kelly Bates, CRM

• General Practice Registered Nurse in Medford, OR
• Providers in Medford, OR by specialty
• General Practice Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2007; 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.