Individual
SUSAN ROBERTA WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,RD,LN,CDE
Contact information
Practice address
516 E. NIZHONI BLVD., GALLUP, NM 87301-5748
(505) 722-1000
(928) 729-8045
Mailing address
P.O. BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(928) 729-8045
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
149
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149
LN
NM
Enumeration date
04/18/2007
Last updated
05/02/2016
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