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General NPI Number Information
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NPI Number | 1750407383
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Entity Type | Individual
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Provider Name | SUSAN JEAN BADER RN
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 2850 N 24TH ST
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City | PHOENIX
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State | AZ
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Zip | 85008-1004
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Country | US
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Telephone | 602-266-5976
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Fax | 602-274-8952
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Provider Business Mailing Address
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Address Line | 2850 N 24TH ST
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City | PHOENIX
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State | AZ
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Zip | 85008-1004
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Country | US
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Telephone | 602-266-5976
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Fax | 602-274-8952
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 99392
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | RN170031
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License Number State | AZ
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