Provider Demographics
NPI:1154354306
Name:ALBRIGHT, SUSAN MARY (RNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:ALBRIGHT
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARY
Other - Last Name:MCCLOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:203 S CANDY LN STE 1A
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-8104
Mailing Address - Country:US
Mailing Address - Phone:928-649-1389
Mailing Address - Fax:
Practice Address - Street 1:203 S CANDY LN
Practice Address - Street 2:SUITE 1A
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4120
Practice Address - Country:US
Practice Address - Phone:928-649-1389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP77768Medicare UPIN
AZ111781Medicare PIN