Healthcare Provider Details

I. General information

NPI: 1295726206
Provider Name (Legal Business Name): DEANNA M SUGGS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REGIONAL ADMIN OFFICE 3411 N 5TH AVE., STE. 209
PHOENIX NM
85013-3812
US

IV. Provider business mailing address

REGIONAL ADMIN OFFICE 3411 N 5TH AVE., STE. 209
PHOENIX NM
85013-3812
US

V. Phone/Fax

Practice location:
  • Phone: 602-789-0344
  • Fax: 602-789-8389
Mailing address:
  • Phone: 602-789-0344
  • Fax: 602-789-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR23249
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00403
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: