MEDICARE: SUSAN A BRICELAND MD PLC

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	363LW0102X	Women's Health Nurse Practitioner	19009	AZ

General Provider Information

NPI Number	:	1780911446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN A BRICELAND MD PLC

Provider Business Mailing Address
First Line	:	13624 W CAMINO DEL SOL STE 200
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-3401
Country	:	US
Telephone Number	:	623-546-6599
Fax Number	:	623-546-2399

Provider Business Practice Location Address
First Line	:	13624 W CAMINO DEL SOL STE 200
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-3401
Country	:	US
Telephone Number	:	623-546-6599
Fax Number	:	623-546-2399

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	SUSAN A BRICELAND
Credential	:	M.D.
Telephone Number	:	623-546-6599

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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