Provider Demographics
NPI:1750672762
Name:VIAUD, SUZIE ALEXANDRA (FNP)
Entity type:Individual
Prefix:
First Name:SUZIE
Middle Name:ALEXANDRA
Last Name:VIAUD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3700
Mailing Address - Country:US
Mailing Address - Phone:928-583-1000
Mailing Address - Fax:866-323-8458
Practice Address - Street 1:3212 N WINDSONG DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2255
Practice Address - Country:US
Practice Address - Phone:928-583-1000
Practice Address - Fax:866-751-4157
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN141369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP01180021OtherRAILROAD MEDICARE
AZ610222Medicaid
AZP01180021OtherRAILROAD MEDICARE