Provider Demographics
NPI:1467418145
Name:ANDERSON, SUSAN (MSN APRN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSN APRN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SCOLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1232 E BROADWAY RD
Mailing Address - Street 2:STE 120
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-784-1514
Mailing Address - Fax:480-967-3528
Practice Address - Street 1:1232 E BROADWAY RD
Practice Address - Street 2:STE 120
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:480-967-3528
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1468363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN063820OtherBOARD OF NURSING
AZAP1468OtherBOARD OF NURSING
AZAP1468OtherBOARD OF NURSING