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Individual

SUSAN J SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
9640 MENAUL BLVD NE, CVS MINUTE CLINIC, ALBUQUERQUE, NM 87112-2217
(505) 294-4167
Mailing address
9640 MENAUL BLVD NE, ALBUQUERQUE, NM 87112-2217
(505) 294-4167

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R30405
NM
363LF0000X
Family Nurse Practitioner
R30405
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000Q2493
NM
Enumeration date
01/29/2007
Last updated
01/29/2015
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