Individual
SUSANN RAVESSOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3500 NORTHRISE DR, LAS CRUCES, NM 88011-7274
(575) 395-7246
Mailing address
PO BOX 221530, EL PASO, TX 79913-4530
(915) 598-7246
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-74298
NM
163W00000X
Registered Nurse
RN430276
CA
363L00000X
Nurse Practitioner
NP10007
CA
363LA2100X
Acute Care Nurse Practitioner
Primary
CNP-01878
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00453277
—
NM
Enumeration date
10/26/2005
Last updated
01/13/2022
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