Provider Demographics
NPI:1457497604
Name:SCOTT, SUSAN A (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 E MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6034
Mailing Address - Country:US
Mailing Address - Phone:602-957-7341
Mailing Address - Fax:
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2624
Practice Address - Country:US
Practice Address - Phone:623-932-1157
Practice Address - Fax:623-932-1045
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN063566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q21918Medicare UPIN
AZZ116043Medicare PIN