Provider Demographics
NPI:1437738051
Name:THOMAS, SUSANNE
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 OAK CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5638
Mailing Address - Country:US
Mailing Address - Phone:406-360-6055
Mailing Address - Fax:
Practice Address - Street 1:340 OAK CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5638
Practice Address - Country:US
Practice Address - Phone:406-360-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date: