Provider Demographics
NPI:1740209436
Name:BARTLETT HACKENMILLER, SUZANNE BARBARA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:BARBARA
Last Name:BARTLETT HACKENMILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:BARBARA
Other - Last Name:GLASCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8405 N PIMA CENTER PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4670
Mailing Address - Country:US
Mailing Address - Phone:480-587-6930
Mailing Address - Fax:480-882-5026
Practice Address - Street 1:8405 N PIMA CENTER PKWY STE 203
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4670
Practice Address - Country:US
Practice Address - Phone:480-587-6930
Practice Address - Fax:480-882-5026
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33955207V00000X
AZ63610207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1233288Medicaid
IAH16950Medicare UPIN
IA1233288Medicaid