Individual
MRS. SUZANNE WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1503 LLANO ST STE B, SANTA FE, NM 87505-2000
(505) 660-5471
Mailing address
PO BOX 129, CERRILLOS, NM 87010-0129
(505) 660-5471
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1723
NM
Other
Enumeration date
05/07/2009
Last updated
05/07/2009
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