Healthcare Provider Details

I. General information

NPI: 1841329307
Provider Name (Legal Business Name): SUSAN LORRAINE GARRISON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 N SILVER ST
SILVER CITY NM
88061-7299
US

IV. Provider business mailing address

2610 N SILVER ST
SILVER CITY NM
88061-7299
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-5318
  • Fax: 575-388-4847
Mailing address:
  • Phone: 575-538-5318
  • Fax: 575-388-4847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR24779
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: