Provider Demographics
NPI:1487841722
Name:CORBETT, SUSAN RENEE (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:CORBETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 N 199TH DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-1775
Mailing Address - Country:US
Mailing Address - Phone:561-479-7844
Mailing Address - Fax:
Practice Address - Street 1:4515 N 199TH DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-1775
Practice Address - Country:US
Practice Address - Phone:561-479-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ292669367A00000X
NC814367A00000X
MNR1203152367A00000X
FLARNP9323486367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487841722Medicaid
P99323Medicare UPIN
VA1487841722Medicaid