Healthcare Provider Details

I. General information

NPI: 1154467579
Provider Name (Legal Business Name): ALYCIA SUSAN ERNST-AMADOR F.N.P., R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYCIA SUSAN ERNST R.N.

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8417 E MCDOWELL RD
SCOTTSDALE AZ
85257-3917
US

IV. Provider business mailing address

5528 E HILLERY DR
SCOTTSDALE AZ
85254-2375
US

V. Phone/Fax

Practice location:
  • Phone: 480-946-3399
  • Fax: 480-946-2559
Mailing address:
  • Phone: 480-399-2497
  • Fax: 480-946-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5137
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN101841
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberB101841
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number2009005747
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: