Healthcare Provider Details

I. General information

NPI: 1093778581
Provider Name (Legal Business Name): SUZANNE CLAIRE LAREAU RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

13308 SILVER PEAK PL NE
ALBUQUERQUE NM
87111-8263
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-5751
Mailing address:
  • Phone: 505-265-1711
  • Fax: 505-256-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: