Provider Demographics
NPI:1457667016
Name:LASALA-WOOD, SUSAN ELAINE (DNP FNP-C, RNFA)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELAINE
Last Name:LASALA-WOOD
Suffix:
Gender:F
Credentials:DNP FNP-C, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 E PINNACLE PEAK RD STE 9
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3460
Mailing Address - Country:US
Mailing Address - Phone:480-267-9111
Mailing Address - Fax:480-454-4897
Practice Address - Street 1:7609 E PINNACLE PEAK RD STE 9
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3460
Practice Address - Country:US
Practice Address - Phone:480-267-9111
Practice Address - Fax:480-454-4897
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3846207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ561697Medicaid
AZ141649Medicare PIN