Provider Demographics
NPI:1245219930
Name:RHOADS, SUSAN L (CNM,MSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:RHOADS
Suffix:
Gender:F
Credentials:CNM,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-9127
Mailing Address - Country:US
Mailing Address - Phone:928-783-1052
Mailing Address - Fax:
Practice Address - Street 1:1945 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6105
Practice Address - Country:US
Practice Address - Phone:928-341-4650
Practice Address - Fax:928-341-9779
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7222176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ342147Medicaid