MEDICARE: SUSAN C RALSTON RN MSN ARNP

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	363LA2100X	Acute Care Nurse Practitioner	RN133535	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
2	RN133535	OTHER	AZ	ST LICENSE

General Provider Information

NPI Number	:	1285616292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN C RALSTON RN MSN ARNP

Provider Business Mailing Address
First Line	:	13640 N PLAZA DEL RIO BLVD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-4846
Country	:	US
Telephone Number	:	623-876-3800
Fax Number	:	623-523-6586

Provider Business Practice Location Address
First Line	:	9165 W THUNDERBIRD RD
Second Line	:	SUITE 101
City	:	PEORIA
State	:	AZ
Zip	:	85381-4847
Country	:	US
Telephone Number	:	623-523-6555
Fax Number	:	623-523-6586

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	01/24/2008

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