Individual
SUSAN MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 264, MPP 388, POLACCA, AZ 86042-4000
(928) 737-6269
Mailing address
PO BOX 4000, POLACCA, AZ 86042-4000
(928) 737-6269
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
200270015CNS
OR
Other
Enumeration date
02/13/2014
Last updated
02/13/2014
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