Healthcare Provider Details

I. General information

NPI: 1285627646
Provider Name (Legal Business Name): SUSAN H. KAZMIERSKI CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3396 STATE ROAD 96,
COYOTE NM
87012-0040
US

IV. Provider business mailing address

PO BOX 158 538 N. PASEO DE ONATE
ESPANOLA NM
87532-0158
US

V. Phone/Fax

Practice location:
  • Phone: 575-638-5487
  • Fax: 575-638-9123
Mailing address:
  • Phone: 505-753-7218
  • Fax: 505-753-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR26380
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00503
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number422
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: