MEDICARE: MRS. SUSAN KIMBERLY MARTIN F.N.P.

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	163WP2201X	Ambulatory Care Registered Nurse	FNP AP0555	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	:	1578507901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN KIMBERLY MARTIN F.N.P.

Provider Business Mailing Address
First Line	:	1002 E MCDOWELL RD
Second Line	:	SUITE 120
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2625
Country	:	US
Telephone Number	:	602-256-2273
Fax Number	:	602-258-5638

Provider Business Practice Location Address
First Line	:	1002 E MCDOWELL RD
Second Line	:	SUITE 120
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2625
Country	:	US
Telephone Number	:	602-256-2273
Fax Number	:	602-258-5638

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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