MEDICARE: SUSAN HILSABECK FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	248647	AZ

General Provider Information

NPI Number	:	1497357990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HILSABECK FNP-C

Provider Business Mailing Address
First Line	:	6912 S QUENTIN ST STE 50
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-4531
Country	:	US
Telephone Number	:	720-282-2377
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 W ORANGE GROVE RD STE 105
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1150
Country	:	US
Telephone Number	:	520-330-3429
Fax Number	:	602-795-8701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	10/21/2022

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