Healthcare Provider Details

I. General information

NPI: 1255346938
Provider Name (Legal Business Name): SUSAN LOUISE VANNUCCI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD STE 143
SCOTTSDALE AZ
85260-1503
US

IV. Provider business mailing address

9377 E BELL RD STE 143
SCOTTSDALE AZ
85260-1503
US

V. Phone/Fax

Practice location:
  • Phone: 480-619-4097
  • Fax: 480-619-4098
Mailing address:
  • Phone: 480-619-4097
  • Fax: 480-619-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number006969
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number6969
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: