Individual
SUSAN DIANE EARLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
465 SAINT MICHAELS DR, SANTA FE, NM 87505-7670
(505) 988-3233
Mailing address
465 SAINT MICHAELS DR, SANTA FE, NM 87505-7670
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10005131
WA
363AS0400X
Surgical Physician Assistant
Primary
PA2005-0049
NM
Other
Enumeration date
12/08/2006
Last updated
12/01/2011
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