Provider Demographics
NPI:1760775837
Name:HARRELL, SUSAN E (NP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:HARRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:S
Other - Middle Name:ELIZABETH
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-685-6002
Practice Address - Street 1:10270 N 67 AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1005
Practice Address - Country:US
Practice Address - Phone:602-389-3560
Practice Address - Fax:623-933-3510
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4024363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health