Healthcare Provider Details

I. General information

NPI: 1114378536
Provider Name (Legal Business Name): SUSAN DAVIS LAC, MAC, RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 E CAMP LOWELL DR
TUCSON AZ
85712-1256
US

IV. Provider business mailing address

8066 E SHADOW CANYON RD
TUCSON AZ
85750-9681
US

V. Phone/Fax

Practice location:
  • Phone: 520-731-5540
  • Fax: 520-731-5541
Mailing address:
  • Phone: 520-979-6403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0833
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: