Individual
SUSAN LEWARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
1202 US HIGHWAY 60 WEST, SOCORRO GENERAL HOSPITAL, SOCORRO, NM 87801
(575) 835-1140
(575) 835-8716
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R15125
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000R9177
—
NM
Enumeration date
08/03/2005
Last updated
08/15/2008
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