Individual
MR. TERRY ALVIN SUMPTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
1600 NORTH MAIN, LOVINGTON, NM 88260-2813
(575) 396-6611
(575) 396-0318
Mailing address
1600 NORTH MAIN, LOVINGTON, NM 88260-2813
(575) 396-6611
(575) 396-0318
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
C00514
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA00964
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y838
BLUE CROSS AR PROVIDER #
AR
Enumeration date
06/16/2006
Last updated
10/12/2012
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