Provider Demographics
NPI:1578654232
Name:RUNDLE, SUSAN MARY (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:RUNDLE
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 1:1200 S CASTLE DOME AVE STE D
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-5305
Mailing Address - Country:US
Mailing Address - Phone:480-494-2465
Mailing Address - Fax:
Practice Address - Street 1:1200 S CASTLE DOME AVE STE D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-5305
Practice Address - Country:US
Practice Address - Phone:480-494-2465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2436363LF0000X
OR201150176NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111780Medicare PIN