Individual
SUSAN KAY BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
105 EAST PINON STREET, MOUNTAINAIR, NM 87036
(505) 847-2271
Mailing address
PO BOX 787, MOUNTAINAIR, NM 87036-0787
(505) 847-2271
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R22221
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002813
LOVELACE HEALTH PLAN
NM
01
—
850206810
TRICARE
NM
05
—
93567
—
NM
01
—
NM006E47
BLUECROSS BLUESHIELD OF NEW MEXICO
NM
01
—
PROVP11807
MOLINA HEALTHCARE
NM
Enumeration date
03/29/2006
Last updated
10/28/2013
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