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General NPI Number Information
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NPI Number | 1821152034
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Entity Type | Individual
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Provider Name | SUSAN M. MCKILLIP FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 9900 BREN RD E
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 866-799-5886
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Fax |
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Provider Business Mailing Address
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Address Line | 1399 W PARK AVE
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City | GILBERT
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State | AZ
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Zip | 85233-5135
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Country | US
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Telephone | 480-507-5715
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Fax | 480-633-8121
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN067339
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License Number State | AZ
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