MEDICARE: SUSAN MARIE JABLONSKI FNP-C, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP10281	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	78919	ID
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CP003124	SD
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	227670	AR
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP115768	TX
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	53781	WY
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	207061	OK
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10022479	OR

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	:	1770659369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE JABLONSKI FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	3409 N 7TH AVE STE C109
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3635
Country	:	US
Telephone Number	:	602-883-2917
Fax Number	:	602-753-9763

Provider Business Practice Location Address
First Line	:	3409 N 7TH AVE STE C109
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3635
Country	:	US
Telephone Number	:	602-883-2917
Fax Number	:	602-753-9763

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	04/22/2025

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