SUSAN BASILICATO (NPI# 1265403851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265403851 |
| Entity Type | Individual |
| Full Name | SUSAN BASILICATO |
| Credential | NP |
| Practice Address |
1200 Mira Mar Ave Medford OR 97504-8546 |
| Mailing Address |
1208 Beall Ln Central Point OR 97502-1573 |
| Practice Telephone | 5416645151 |
| Mailing Telephone | 5416645151 |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2007-11-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WG0000X |
Registered Nurse Specialization: General Practice |
07804146RN | OR | Nursing Service Providers |
| Street Address |
1200 MIRA MAR AVE |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-8546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639170988 | Rogue Valley Manor | Skilled Nursing Facility | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2005-08-09 |
| 1649816745 | Allison Jensen | Dietitian, Registered | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2019-11-23 |
| 1295386639 | Junne Licata | Physical Therapy Assistant | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2019-09-26 |
| 1093286494 | Kelly Ann Reid | Speech-Language Pathologist | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2018-12-10 |
| 1619463817 | Amy Baumgart | Physical Therapist | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2018-07-10 |
| 1376035253 | Karen A Campbell | Physical Therapy Assistant | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2018-06-05 |
| 1205343860 | Erin Tyler Bayne | Physical Therapist | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2018-01-04 |
| 1639697725 | Joshua Steinhoefel | Physical Therapy Assistant | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2017-09-08 |
| 1487062170 | Kerstie Kneeland | Physical Therapist | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2014-07-26 |
| 1447680293 | Theresa Selvy | Dietitian, Registered | 1200 Mira Mar Ave, Medford, OR 97504-8546 | 2013-11-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 163WG0000X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366042418 | Sarah Hassan | Registered Nurse | 298 Fellsway W, Medford, MA 02155-2646 | 2020-10-28 |
| 1033635388 | Kaeli Jo Harney | Registered Nurse | 28 Golden Ave, Medford, MA 02155-6104 | 2017-08-18 |
| 1104181445 | Ann Peterson | Registered Nurse | 2 Daly Rd, Medford, MA 02155-3702 | 2012-07-12 |
| 1053557413 | Kathryn A Warner | Registered Nurse | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2009-01-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376181313 | Silvia Maciel | Registered Nurse | 1151 May St Ste 201, Hood River, OR 97031-1526 | 2019-12-19 |
| 1982124970 | Brenda Backhaus | Registered Nurse | 5935 Sladen Ave, Gladstone, OR 97027-1952 | 2017-06-21 |
| 1568906550 | Nancy Jane Spiegel | Registered Nurse | 13925 Sw Bonnie Brae Ct, Beaverton, OR 97005-4320 | 2016-12-08 |
| 1356707624 | Timothy Lee Unger | Registered Nurse | 3785 Se 317th Ave, Troutdale, OR 97060-9401 | 2016-01-02 |
| 1376888479 | Jill Marie Riffe | Registered Nurse | 10633 Se Flavel St, Portland, OR 97266-6026 | 2012-11-30 |
| 1124319306 | Julie Ann Brown | Registered Nurse | 2765 Sw 24th St, Gresham, OR 97080-5207 | 2011-04-22 |
| 1922215698 | Ellen G. Frichette | Registered Nurse | 1339 Ne Ford St, Mcminnville, OR 97128-3634 | 2007-05-16 |
| 1942256730 | Elaine Marian Hooper | Registered Nurse | 385 Ranch Road, Reedsport, OR 97467 | 2006-05-25 |
| 1285698555 | Jacqualine M Terrill Cooke | Registered Nurse | 320 Se Baker St, Mcminnville, OR 97128-6038 | 2006-04-13 |
| 1083693295 | Sharon Dixie Mcconnell | Registered Nurse | 9911 Se Mount Scott Blvd, Portland, OR 97266-6302 | 2006-01-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.