Healthcare Provider Details

I. General information

NPI: 1487685723
Provider Name (Legal Business Name): SUSAN STEPHANIE WARMUS PA-SURGERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSIE STEPHANIE WARMUS PA-SURGERY

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 S CARRIAGE LANE
MESA AZ
85202
US

IV. Provider business mailing address

PO BOX 40760
MESA AZ
85274
US

V. Phone/Fax

Practice location:
  • Phone: 480-706-9430
  • Fax: 480-706-1285
Mailing address:
  • Phone: 480-706-9430
  • Fax: 480-706-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: