Provider Demographics
NPI:1255430187
Name:MUSAL, SUSAN M (CNP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:MUSAL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 W COBBS PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9653
Mailing Address - Country:US
Mailing Address - Phone:440-668-6797
Mailing Address - Fax:
Practice Address - Street 1:3611 W COBBS PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9653
Practice Address - Country:US
Practice Address - Phone:440-668-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
OHCOA.06464-NP363L00000X
AZ223527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No174H00000XOther Service ProvidersHealth Educator
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005873Medicaid