Provider Demographics
NPI:1346346178
Name:PEPPERS, SUSAN (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PEPPERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:EVERINGHAM-MOSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:14416 WEST MEEKER BLVD
Mailing Address - Street 2:BANNER ARIZONA HEALTH CLINIC, SUN CITY WEST
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375
Mailing Address - Country:US
Mailing Address - Phone:623-876-3980
Mailing Address - Fax:805-681-1768
Practice Address - Street 1:215 PESETAS LN
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1416
Practice Address - Country:US
Practice Address - Phone:805-681-1761
Practice Address - Fax:805-681-1768
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS46631Medicare UPIN
546631Medicare UPIN
CAWNP11748AMedicare PIN