Healthcare Provider Details

I. General information

NPI: 1427109818
Provider Name (Legal Business Name): SUSAN PLOURDE LIC. AC., DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 CANDELARIA RD NE STE. F
ALBUQUERQUE NM
87112-1457
US

IV. Provider business mailing address

520 SEWARD PARK AVE NE
ALBUQUERQUE NM
87123-5434
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-3233
  • Fax:
Mailing address:
  • Phone: 505-266-2156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number492
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: