Provider Demographics
NPI:1093774945
Name:LIEBHERR, SUSAN M (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:LIEBHERR
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:DANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7552 W COUNTRY GABLES DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4392
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2601 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4973
Practice Address - Country:US
Practice Address - Phone:602-344-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN036063363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ637655Medicaid
AZ637655Medicaid
AZZ144600Medicare PIN
AZZ133941Medicare PIN