1760443337 NPI number — SUSAN JILL APPLETON CRNA

Table of content: SUSAN JILL APPLETON CRNA (NPI 1760443337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760443337 NPI number — SUSAN JILL APPLETON CRNA

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760443337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1193
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLOBE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85502-1193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5880 S HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLOBE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85501-9447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-402-1217
Provider Business Practice Location Address Fax Number:
888-321-1535
Provider Enumeration Date:
03/31/2006

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: 367500000X , with the licence number:  CRNA1107 , 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)

  • Identifier: 010151121 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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