Individual
MS. SUSAN NICOLE DAMICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
14200 W CELEBRATE LIFE WAY, GOODYEAR, AZ 85338-3007
(623) 207-3904
Mailing address
14200 W CELEBRATE LIFE WAY, GOODYEAR, AZ 85338-3007
(623) 207-3904
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
F331840-1
NY
363L00000X
Nurse Practitioner
SP006559B
PA
363L00000X
Nurse Practitioner
Primary
TAP8519
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01932961
—
NY
01
—
500014013
RR MEDICARE PIN
NY
01
—
CC8362
RR MEDICARE GROUP
NY
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039841
MEDICARE GROUP
PA
01
—
P00199366
RR MEDICARE PIN
PA
Enumeration date
03/16/2006
Last updated
03/15/2016
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