MEDICARE: SUSAN WILLEVER N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP7450	AZ

General Provider Information

NPI Number	:	1134527534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN WILLEVER N.P.

Provider Business Mailing Address
First Line	:	11331 E STARFIRE CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-7062
Country	:	US
Telephone Number	:	480-686-0170
Fax Number	:

Provider Business Practice Location Address
First Line	:	11331 E STARFIRE CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-7062
Country	:	US
Telephone Number	:	480-686-0170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2014
Last Update Date	:	12/17/2014

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Directions to “ SUSAN WILLEVER N.P.” Practice Location

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