Healthcare Provider Details

I. General information

NPI: 1437571023
Provider Name (Legal Business Name): SUSAN ZOOK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CANYON RD STE A1
BULLHEAD CITY AZ
86442-8492
US

IV. Provider business mailing address

2500 CANYON RD STE A1
BULLHEAD CITY AZ
86442-8492
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-4499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP7299
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: