Individual
SUZANNE RAE SALEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
601 W MINGUS AVE, COTTONWOOD, AZ 86326
(928) 649-3805
(928) 649-5843
Mailing address
4801 W ECHO LANE, GLENDALE, AZ 85302
(602) 292-4997
(623) 939-4849
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN034491
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433871
—
AZ
Enumeration date
07/20/2006
Last updated
12/06/2007
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