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General NPI Number Information
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NPI Number | 1043439078
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Entity Type | Individual
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Provider Name | SUZANNE L. NELSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 303 E BASELINE RD STE 306
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City | PHOENIX
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State | AZ
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Zip | 85042-6574
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Country | US
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Telephone | 602-305-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 1741 S CLEARVIEW AVE UNIT 77
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City | MESA
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State | AZ
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Zip | 85209-4011
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Country | US
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Telephone | 480-807-9114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2842
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License Number State | AZ
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