Healthcare Provider Details

I. General information

NPI: 1396852737
Provider Name (Legal Business Name): SUSAN DALE MARKOVICH R.N., M.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W. ST . MARY'S RD.
TUCSON AZ
85745-2623
US

IV. Provider business mailing address

7606 N CAMINO SIN VACAS
TUCSON AZ
85718-1298
US

V. Phone/Fax

Practice location:
  • Phone: 520-872-6805
  • Fax: 520-872-5495
Mailing address:
  • Phone: 520-219-6494
  • Fax: 520-219-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN103875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: