Provider Demographics
NPI:1124150404
Name:DOBIS, SUSAN KAREN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAREN
Last Name:DOBIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 SO. OAKRIDGE DRIVE
Mailing Address - Street 2:P.O. BOX 475
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615
Mailing Address - Country:US
Mailing Address - Phone:520-366-4139
Mailing Address - Fax:
Practice Address - Street 1:905 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5456
Practice Address - Country:US
Practice Address - Phone:520-515-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN102191163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool