Healthcare Provider Details

I. General information

NPI: 1467766899
Provider Name (Legal Business Name): SUSAN A ORSICH RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20414 N 27TH AVE
PHOENIX AZ
85027-3250
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 602-849-0115
  • Fax: 602-246-7029
Mailing address:
  • Phone: 702-579-3203
  • Fax: 702-838-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberRN109739
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3656
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: