Provider Demographics
NPI:1730200718
Name:KRELIC, SUSAN E (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:KRELIC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15781 S MAVERICK TRL
Mailing Address - Street 2:
Mailing Address - City:MAYER
Mailing Address - State:AZ
Mailing Address - Zip Code:86333-2309
Mailing Address - Country:US
Mailing Address - Phone:602-232-4983
Mailing Address - Fax:602-243-4926
Practice Address - Street 1:6000 S 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-4209
Practice Address - Country:US
Practice Address - Phone:602-232-4983
Practice Address - Fax:602-243-4926
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN032453163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ761842OtherAHCCCS ID #