Healthcare Provider Details

I. General information

NPI: 1245481795
Provider Name (Legal Business Name): SUSAN JANE TURNER RN,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WEMINUCHE
IGNACIO CO
81137-0899
US

IV. Provider business mailing address

PO BOX 899 123 WEMINUCHE
IGNACIO CO
81137-0899
US

V. Phone/Fax

Practice location:
  • Phone: 970-563-4581
  • Fax:
Mailing address:
  • Phone: 970-563-4581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number165904
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number165904
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number165904
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: