Provider Demographics
NPI:1194781435
Name:HIMMELBERGER, SUE (WHC-NP)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:HIMMELBERGER
Suffix:
Gender:F
Credentials:WHC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 W UNION HILLS DR
Mailing Address - Street 2:SUITE 1400B
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1096
Mailing Address - Country:US
Mailing Address - Phone:623-561-0043
Mailing Address - Fax:623-561-1928
Practice Address - Street 1:6320 W UNION HILLS DR
Practice Address - Street 2:SUITE 1400B
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1096
Practice Address - Country:US
Practice Address - Phone:623-561-0043
Practice Address - Fax:623-561-1928
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1124364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ595499Medicaid
AZZ70593Medicare PIN
AZ595499Medicaid