Provider Demographics
NPI:1619844834
Name:HIRALEZ, SUSANNAH RAE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:RAE
Last Name:HIRALEZ
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10636 W CORONADO RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4784
Mailing Address - Country:US
Mailing Address - Phone:602-910-7353
Mailing Address - Fax:
Practice Address - Street 1:10636 W CORONADO RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4784
Practice Address - Country:US
Practice Address - Phone:602-910-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ329796363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health