Healthcare Provider Details

I. General information

NPI: 1760787592
Provider Name (Legal Business Name): SUSAN L AMES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18215 TRAIL WEST DR
BUENA VISTA CO
81211-9130
US

IV. Provider business mailing address

18215 TRAIL WEST DR
BUENA VISTA CO
81211-9130
US

V. Phone/Fax

Practice location:
  • Phone: 719-395-5839
  • Fax:
Mailing address:
  • Phone: 719-395-5839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number189329
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number189329
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: