Healthcare Provider Details

I. General information

NPI: 1114119146
Provider Name (Legal Business Name): SUSAN LYNN FORBES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 INDIAN SCHOOL RD NE ATTN: HEALTH SERVICES
ALBUQUERQUE NM
87110-3988
US

IV. Provider business mailing address

1372 REYNOSA LOOP SE
RIO RANCHO NM
87124-8741
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-3859
  • Fax:
Mailing address:
  • Phone: 585-892-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR21511
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: