Provider Demographics
NPI:1043217755
Name:SPEAR, SUSAN ELAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELAINE
Last Name:SPEAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELAINE
Other - Last Name:ERB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1969 FOREST HILLS RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5508
Mailing Address - Country:US
Mailing Address - Phone:480-398-6954
Mailing Address - Fax:
Practice Address - Street 1:1090 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305
Practice Address - Country:US
Practice Address - Phone:928-583-1000
Practice Address - Fax:866-323-8458
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP FURNISHING 12516363LP0808X
AZ3931363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health