1154467579 NPI number — MRS. ALYCIA SUSAN ERNST-AMADOR F.N.P., R.N.

Table of content: MRS. ALYCIA SUSAN ERNST-AMADOR F.N.P., R.N. (NPI 1154467579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154467579 NPI number — MRS. ALYCIA SUSAN ERNST-AMADOR F.N.P., R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERNST-AMADOR
Provider First Name:
ALYCIA
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
F.N.P., R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERNST
Provider Other First Name:
ALYCIA
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154467579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5528 E HILLERY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85254-2375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-399-2497
Provider Business Mailing Address Fax Number:
480-946-2559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8417 E MCDOWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85257-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-946-3399
Provider Business Practice Location Address Fax Number:
480-946-2559
Provider Enumeration Date:
01/30/2007

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:  AP5137 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN101841 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WS0200X , with the licence number: B101841 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SC1501X , with the licence number: 2009005747 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 891748 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".