1558541680 NPI number — MISS SUZANNE LEIGH SEXTON PA-C

Table of content: MISS SUZANNE LEIGH SEXTON PA-C (NPI 1558541680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558541680 NPI number — MISS SUZANNE LEIGH SEXTON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEXTON
Provider First Name:
SUZANNE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1558541680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11960 LIONESS WAY 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80134-5644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-695-6106
Provider Business Mailing Address Fax Number:
303-695-1211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
395 N SILVERBELL RD
Provider Second Line Business Practice Location Address:
#315
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745-2675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-623-8475
Provider Business Practice Location Address Fax Number:
520-297-3539
Provider Enumeration Date:
11/06/2007

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: 363A00000X , with the licence number:  4280 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 299343 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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