Provider Demographics
NPI:1003267873
Name:DEYOE, SUSAN JOY (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JOY
Last Name:DEYOE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:JOY
Other - Last Name:DEYOE-PHEBUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 4000
Mailing Address - Street 2:
Mailing Address - City:KEAMS CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:86042
Mailing Address - Country:US
Mailing Address - Phone:928-737-6387
Mailing Address - Fax:
Practice Address - Street 1:HWY 264 MP 388
Practice Address - Street 2:
Practice Address - City:KEAMS CANYON
Practice Address - State:AZ
Practice Address - Zip Code:86042
Practice Address - Country:US
Practice Address - Phone:928-737-6387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO097192163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse