1346346178 NPI number — SUSAN PEPPERS FNP

Table of content: SUSAN PEPPERS FNP (NPI 1346346178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346346178 NPI number — SUSAN PEPPERS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEPPERS
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVERINGHAM-MOSIER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346346178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14416 WEST MEEKER BLVD
Provider Second Line Business Mailing Address:
BANNER ARIZONA HEALTH CLINIC, SUN CITY WEST
Provider Business Mailing Address City Name:
SUN CITY WEST
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-876-3980
Provider Business Mailing Address Fax Number:
805-681-1768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 PESETAS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93110-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-681-1761
Provider Business Practice Location Address Fax Number:
805-681-1768
Provider Enumeration Date:
09/16/2006

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:  NP11748 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com