Healthcare Provider Details

I. General information

NPI: 1104045582
Provider Name (Legal Business Name): SUZETTE MARIE FISHER ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N. PARKVIEW PLACE
SURPRISE AZ
85374
US

IV. Provider business mailing address

22119 N PEDREGOSA DR
SUN CITY WEST AZ
85375-2695
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax:
Mailing address:
  • Phone: 623-476-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: