Most Relevant Information
Provider Data
| NPI Number: | 1003424102 |
| Provider Name: | SUSANNAMMA LIJAN PMHNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 246807 |
Most Important Dates
| Enumeration Date: | 07/15/2020 |
| Last Updated: | 10/19/2020 |
Provider Practice Location
2601 E ROOSEVELT ST
PHOENIX
AZ
850084973
Practice Location Phone/Fax
| Phone: | 6023445345 |
| Fax: |
Provider Mailing Location
2601 E ROOSEVELT ST
PHOENIX
AZ
850084973
Provider Mailing Phone/Fax
| Phone: | 6023445345 |
| Fax: |