Provider Demographics
NPI:1023061637
Name:HALT, SUZANNE L (CNM)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:HALT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:AYMAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:5605 W EUGIE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1273
Mailing Address - Country:US
Mailing Address - Phone:480-756-0000
Mailing Address - Fax:480-546-4136
Practice Address - Street 1:5605 W EUGIE AVE STE 11
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1272
Practice Address - Country:US
Practice Address - Phone:480-756-6000
Practice Address - Fax:866-636-8770
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10780367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ776685Medicaid