MEDICARE: SUSAN MURPHY FNP

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	363LF0000X	Family Nurse Practitioner	AP7984	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205239324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MURPHY FNP

Provider Business Mailing Address
First Line	:	2030 W BASELINE RD STE 182-549
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6574
Country	:	US
Telephone Number	:	928-683-1170
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 W BASELINE RD STE 182-549
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6574
Country	:	US
Telephone Number	:	928-683-1170
Fax Number	:

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

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	09/07/2021

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