MEDICARE: MS. SUSAN JANE GERACE 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	RN038613	AZ

General Provider Information

NPI Number	:	1306956784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN JANE GERACE N.P.

Provider Business Mailing Address
First Line	:	4220 N 20TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-5101
Country	:	US
Telephone Number	:	602-279-7655
Fax Number	:	602-253-8891

Provider Business Practice Location Address
First Line	:	1930 S ALMA SCHOOL RD
Second Line	:	STE. A104
City	:	MESA
State	:	AZ
Zip	:	85210-3064
Country	:	US
Telephone Number	:	483-820-0825
Fax Number	:	480-820-7863

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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