Provider Demographics
NPI:1396852737
Name:MARKOVICH, SUSAN DALE (RN, MSN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DALE
Last Name:MARKOVICH
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7606 N CAMINO SIN VACAS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1298
Mailing Address - Country:US
Mailing Address - Phone:520-219-6494
Mailing Address - Fax:520-219-6336
Practice Address - Street 1:1601 W. ST . MARY'S RD.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2623
Practice Address - Country:US
Practice Address - Phone:520-872-6805
Practice Address - Fax:520-872-5495
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN103875163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult