MEDICARE: SUSAN A HECK 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	363LF0000X	Family Nurse Practitioner	040217	AZ

General Provider Information

NPI Number	:	1912959552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A HECK F.N.P

Provider Business Mailing Address
First Line	:	7200 W BELL RD
Second Line	:	A-1
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8529
Country	:	US
Telephone Number	:	623-334-4000
Fax Number	:	623-334-4400

Provider Business Practice Location Address
First Line	:	7200 W BELL RD
Second Line	:	A-1
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8529
Country	:	US
Telephone Number	:	623-334-4000
Fax Number	:	623-334-4400

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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