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General NPI Number Information
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NPI Number | 1063188381
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Entity Type | Individual
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Provider Name | SUE ANN SUNDERLAND RN
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 1530 W GLENDALE AVE STE 105
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City | PHOENIX
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State | AZ
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Zip | 85021-8578
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Country | US
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Telephone | 602-995-3395
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Fax |
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Provider Business Mailing Address
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Address Line | 4221 W YORKSHIRE DR
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City | GLENDALE
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State | AZ
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Zip | 85308-7556
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Country | US
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Telephone | 623-694-5364
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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 | 163WX1100X
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Taxonomy Name | Ophthalmic Registered Nurse
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License Number | RN054207
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License Number State | AZ
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