Healthcare Provider Details

I. General information

NPI: 1952818700
Provider Name (Legal Business Name): SUZANNE STORMENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E APACHE ST
FARMINGTON NM
87401-6925
US

IV. Provider business mailing address

607 E APACHE ST
FARMINGTON NM
87401-6925
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-2012
  • Fax: 505-326-2012
Mailing address:
  • Phone: 505-326-2012
  • Fax: 505-326-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number216970
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: