Provider Demographics
NPI:1497570881
Name:SUAN, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 E BELLERIVE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0038
Mailing Address - Country:US
Mailing Address - Phone:480-200-4356
Mailing Address - Fax:480-841-6652
Practice Address - Street 1:1932 E JEANINE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3415
Practice Address - Country:US
Practice Address - Phone:480-831-7331
Practice Address - Fax:480-841-6652
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL4495H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility