Individual
SUSIE A JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD MPH
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
85216
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30487064
—
CO
05
—
35568
—
NM
05
—
939572
—
AZ
Enumeration date
10/14/2005
Last updated
12/26/2007
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