Provider Demographics
NPI:1871990408
Name:SLUDER, SALLY MELISSA (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:MELISSA
Last Name:SLUDER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E CAMELBACK RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4219
Mailing Address - Country:US
Mailing Address - Phone:602-778-3601
Mailing Address - Fax:602-445-9390
Practice Address - Street 1:351 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914
Practice Address - Country:US
Practice Address - Phone:541-881-7423
Practice Address - Fax:541-881-2323
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126760363LA2100X
OR201502432NP-PP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care