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Individual

MRS. SUSAN ELLEN RAGO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 327-4796
(505) 325-9113
Mailing address
PO BOX 445, AZTEC, NM 87410-0445
(505) 327-4796
(505) 325-9113

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
94-PA33
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
87715
NM
Enumeration date
07/14/2006
Last updated
07/08/2007
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