Doctor Name: | MS. SUSAN CONSTANCE |
NPI Number: | 1467476440 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 126420 |
Business Practice Address: | 500 North Mundo Dulce, NM - 875280269 |
Business Phone Number: | 5057593291 |
Business Fax Number: | 5057597294 |
Mailing Address: | Po Box 269, DULCE |
State: | NM |
Postal Code: | 875280269 |
Phone Number: | 5057591691 |
Fax Number: | 5057597294 |
NPI Enumeration Date: | 07/26/2006 |
NPI Last Update Date: | 09/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP2201X |
License Number: | 126420 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Ambulatory Care |
Taxonomy Definition: |