Healthcare Provider Details

I. General information

NPI: 1396432332
Provider Name (Legal Business Name): PAMELA JEAN SUAREZ APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE A
LAS CRUCES NM
88001-3117
US

IV. Provider business mailing address

4560 REAL DEL SUR
LAS CRUCES NM
88011-7226
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-4602
  • Fax:
Mailing address:
  • Phone: 575-993-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number73211
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: