Provider Demographics
NPI:1063188381
Name:SUNDERLAND, SUE ANN (RN)
Entity type:Individual
Prefix:
First Name:SUE ANN
Middle Name:
Last Name:SUNDERLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 W YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7556
Mailing Address - Country:US
Mailing Address - Phone:623-694-5364
Mailing Address - Fax:
Practice Address - Street 1:1530 W GLENDALE AVE STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8578
Practice Address - Country:US
Practice Address - Phone:602-995-3395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN054207163WX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX1100XNursing Service ProvidersRegistered NurseOphthalmic