Healthcare Provider Details

I. General information

NPI: 1033944038
Provider Name (Legal Business Name): SUZAN AL-SALEH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W ELLIOT RD STE 115
GILBERT AZ
85233-5301
US

IV. Provider business mailing address

725 W ELLIOT RD STE 115
GILBERT AZ
85233-5301
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-0000
  • Fax:
Mailing address:
  • Phone: 480-545-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number308366
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: