Provider Demographics
NPI:1538623269
Name:ANDERSON, SUSAN CLAIRE GUCCIARDI (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CLAIRE GUCCIARDI
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16450 W VAN BUREN ST
Mailing Address - Street 2:APT 2095
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1618
Mailing Address - Country:US
Mailing Address - Phone:586-615-7595
Mailing Address - Fax:
Practice Address - Street 1:214 SADDLE LN
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-6717
Practice Address - Country:US
Practice Address - Phone:586-615-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant