Healthcare Provider Details

I. General information

NPI: 1164341731
Provider Name (Legal Business Name): LARI SUZANNE RYAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7233 E BASELINE RD STE 123
MESA AZ
85209-5007
US

IV. Provider business mailing address

18659 E APRICOT LN
QUEEN CREEK AZ
85142-3524
US

V. Phone/Fax

Practice location:
  • Phone: 480-832-7546
  • Fax:
Mailing address:
  • Phone: 480-353-6714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342844
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: