Basic Information
| Provider Information | |||||||||
| NPI: | 1487845558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSGROVE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RN,APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10880 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863040880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287595935 | ||||||||
| FaxNumber: | 9284582083 | ||||||||
| Practice Location | |||||||||
| Address1: | 3345 N WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863142283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285836411 | ||||||||
| FaxNumber: | 9287725445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP2755 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.