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General NPI Number Information
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NPI Number | 1336496330
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Entity Type | Individual
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Provider Name | SUSAN JO PONDER RN, CNS/RXN
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Gender | Female
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 05/31/2021
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Provider Practice Location Address
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Address Line | 1919 65TH AVE STE 3
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City | GREELEY
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State | CO
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Zip | 80634-7965
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Country | US
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Telephone | 970-590-1138
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Fax | 970-356-7437
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Provider Business Mailing Address
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Address Line | 1919 65TH AVENUE, SUITE 3 INTEGRATION MENTAL HEALTH
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City | GREELEY
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State | CO
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Zip | 80634
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Country | US
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Telephone | 970-590-1138
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Fax | 970-356-7437
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 130627
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License Number State | CO
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