Healthcare Provider Details

I. General information

NPI: 1427160282
Provider Name (Legal Business Name): SUSAN FRANCES DONLON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 STONE LAKE RD
DULCE NM
87528
US

IV. Provider business mailing address

43 OAKWOOD CIR
PAGOSA SPRINGS CO
81147-9354
US

V. Phone/Fax

Practice location:
  • Phone: 505-759-7216
  • Fax: 505-759-7289
Mailing address:
  • Phone: 970-731-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number52753
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: