Provider Demographics
NPI:1306451950
Name:WILSON, SUSAN ANN (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11922 W VILLA CHULA CT
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-5420
Mailing Address - Country:US
Mailing Address - Phone:623-383-3272
Mailing Address - Fax:
Practice Address - Street 1:31501 N WESTLAND RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7846
Practice Address - Country:US
Practice Address - Phone:623-773-6579
Practice Address - Fax:623-773-6580
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ223536163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool