Healthcare Provider Details

I. General information

NPI: 1568681427
Provider Name (Legal Business Name): SUZANNE RUTH ABRAM R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E AEPLI DR
TEMPE AZ
85282-2205
US

IV. Provider business mailing address

1730 E BAKER DR
TEMPE AZ
85282-7207
US

V. Phone/Fax

Practice location:
  • Phone: 480-967-6599
  • Fax: 480-921-0814
Mailing address:
  • Phone: 480-967-6599
  • Fax: 480-921-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN036227
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: