Susan Walls-Bortman, N.P.

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

AP1736 Issued in AZ

Practice address

174 S Coronado Dr Ste a
Sierra Vista, AZ 85635-6356

Phone

(520) 545-0676

Fax

(520) 547-2993

NPI assigned

Jun 9, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arizona Family Care Associates, Inc.

  • Internal Medicine Physician
  • Sierra Vista, AZ
  • NPI 1265462006
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524009600000",
    "number": "1679514830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 N. WYATT DRIVE",
            "address_2": "SECOND FLOOR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85712",
            "telephone_number": "520-545-0608",
            "fax_number": "520-795-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 S CORONADO DR STE A",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856356356",
            "telephone_number": "520-545-0676",
            "fax_number": "520-547-2993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS-BORTMAN",
        "first_name": "SUSAN",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2018-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "043027",
            "primary": false
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "AZ",
            "license": "AP1736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "817223",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessa Vu
• Omar Waheed, D.O
• Gina Michelle Wales, RN
• Walgreen Co
• Aldra Walker
• Walmart Inc.
• Walmart, Inc.
• Deborah Ward
• Gayle W Ward
• Lorena Warren, FNP-C

• Obstetrics & Gynecology Nurse Practitioner in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Obstetrics & Gynecology Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.