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General NPI Number Information
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NPI Number | 1982420030
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Entity Type | Individual
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Provider Name | SUSAN KERUBO NYAENYA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 2620 N 68TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-1202
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Country | US
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Telephone | 623-462-2803
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 S DOBSON RD
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City | MESA
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State | AZ
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Zip | 85202-2916
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Country | US
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Telephone | 480-321-5348
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | PMH10240083
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License Number State | AZ
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