Provider Demographics
NPI:1770659369
Name:JABLONSKI, SUSAN MARIE (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:JABLONSKI
Suffix:
Gender:
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:PENDERGAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3409 N 7TH AVE STE C109
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3635
Mailing Address - Country:US
Mailing Address - Phone:602-883-2917
Mailing Address - Fax:602-753-9763
Practice Address - Street 1:3409 N 7TH AVE STE C109
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3635
Practice Address - Country:US
Practice Address - Phone:602-883-2917
Practice Address - Fax:602-753-9763
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10281363LP0808X
ID78919363LP0808X
SDCP003124363LP0808X
AR227670363LP0808X
TXAP115768363LP0808X
WY53781363LP0808X
OK207061363LP0808X
OR10022479363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1867632-01Medicaid
TX8J5982Medicare PIN