Healthcare Provider Details

I. General information

NPI: 1760775837
Provider Name (Legal Business Name): SUSAN E HARRELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: S ELIZABETH HARRELL NP

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10270 N 67 AVE SUITE 106
GLENDALE AZ
85302-1005
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 200
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 602-389-3560
  • Fax: 623-933-3510
Mailing address:
  • Phone: 602-685-6000
  • Fax: 602-685-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP4024
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: