Provider Demographics
NPI:1922045160
Name:MEDLEN, SUE M (NP)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:M
Last Name:MEDLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 N ALVERNON WAY
Mailing Address - Street 2:SUITE 216 ARIZONA COMMUNITY PHYSICIANS PC
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:6130 N LA CHOLLA B
Practice Address - Street 2:ARIZONA COMMUNITY PHYSICIANS PC
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-742-4159
Practice Address - Fax:520-742-3493
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN057058363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ119666Medicare PIN
AZZ102076Medicare PIN
P46215Medicare UPIN