MEDICARE: MS. SUZANNE RUTH ABRAM R.N.

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	163WP0200X	Pediatric Registered Nurse	RN036227	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568681427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE RUTH ABRAM R.N.

Provider Business Mailing Address
First Line	:	1730 E BAKER DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7207
Country	:	US
Telephone Number	:	480-967-6599
Fax Number	:	480-921-0814

Provider Business Practice Location Address
First Line	:	311 E AEPLI DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-2205
Country	:	US
Telephone Number	:	480-967-6599
Fax Number	:	480-921-0814

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/09/2007

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