Provider Demographics
NPI:1063688455
Name:WILLIAMS, SUSAN M (NMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1144 E MCDOWELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2664
Mailing Address - Country:US
Mailing Address - Phone:602-307-5330
Mailing Address - Fax:602-307-5021
Practice Address - Street 1:1144 E MCDOWELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2664
Practice Address - Country:US
Practice Address - Phone:602-307-5330
Practice Address - Fax:602-307-5021
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01-659175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath