MEDICARE: SUSAN BUXBAUM DNP, RN, CPNP-PC

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	163W00000X	Registered Nurse	RN106996	AZ
2	163WP0200X	Pediatric Registered Nurse	RN106996	AZ
3	363LP0200X	Pediatric Nurse Practitioner	254993	AZ

General Provider Information

NPI Number	:	1861823122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BUXBAUM DNP, RN, CPNP-PC

Provider Business Mailing Address
First Line	:	2329 E AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-6215
Country	:	US
Telephone Number	:	520-724-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2329 E AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-6215
Country	:	US
Telephone Number	:	520-724-6600
Fax Number	:

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

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	04/09/2021

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