Individual
MS. SUSAN CONSTANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
500 NORTH MUNDO, DULCE, NM 87528-0269
(505) 759-3291
(505) 759-7294
Mailing address
PO BOX 269, DULCE, NM 87528-0269
(505) 759-1691
(505) 759-7294
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
126420
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
07/26/2006
Last updated
09/20/2010
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