| Doctor Name: | SUSAN MATHEW |
| NPI Number: | 1275957052 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 200270015CNS |
| Business Practice Address: | Hwy 264, Mpp 388 Polacca, AZ - 860424000 |
| Business Phone Number: | 9287376269 |
| Business Fax Number: | |
| Mailing Address: | Po Box 4000, POLACCA |
| State: | AZ |
| Postal Code: | 860424000 |
| Phone Number: | 9287376269 |
| Fax Number: | |
| NPI Enumeration Date: | 02/13/2014 |
| NPI Last Update Date: | 02/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SA2200X |
| License Number: | 200270015CNS |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |