1275771834 NPI number — MISS SUSAN JANE GRANT PMHNP-BC, FNP-BC

Table of content: MISS SUSAN JANE GRANT PMHNP-BC, FNP-BC (NPI 1275771834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275771834 NPI number — MISS SUSAN JANE GRANT PMHNP-BC, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
SUSAN
Provider Middle Name:
JANE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275771834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1075 E FORT LOWELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85719-2159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-327-4505
Provider Business Mailing Address Fax Number:
520-202-1707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 N. ALVERNON WAY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-694-8888
Provider Business Practice Location Address Fax Number:
520-694-1640
Provider Enumeration Date:
02/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP3591 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP3591 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com