Susan Herbstritt

Individual provider Active NPI Licensed Practical Nurse · Kayenta, AZ

NPI 1154744811 · NPPES record last updated Jan 30, 2014

Key facts

NPI
1154744811
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
PN259312L (PA)
Practice address
Hwy160/163, BLDG Ka 2010
Kayenta, AZ 86033-0368
Phone
(928) 697-4110
Fax
(928) 697-4083
NPI assigned
Jan 30, 2014
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PN259312LPAMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X PN259312L PA Yes

Addresses

Primary practice location

Hwy160/163, BLDG Ka 2010
Kayenta, AZ 86033-0368

Mailing address

Hwy160/163, BLDG Ka 2010
Kayenta, AZ 86033-0368
Phone (928) 697-4110

Other providers in Kayenta, AZ

All providers in Kayenta, AZ · Licensed Practical Nurse in Arizona

Sources for this page

Verify at the official NPI Registry.