Healthcare Provider Details

I. General information

NPI: 1922380930
Provider Name (Legal Business Name): SUZANNE LYONS RAUCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 204
PHOENIX AZ
85016-4876
US

IV. Provider business mailing address

2222 E HIGHLAND AVE STE 204
PHOENIX AZ
85016-4876
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-4834
  • Fax: 602-254-5178
Mailing address:
  • Phone: 602-264-4834
  • Fax: 602-254-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4957
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: