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General NPI Number Information
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NPI Number | 1467195875
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Entity Type | Individual
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Provider Name | SUSAN GILBERT NP
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Gender | Female
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 555 S SCHWARTZ AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-5955
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Country | US
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Telephone | 505-609-6680
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Fax |
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Provider Business Mailing Address
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Address Line | 2837 NEW LANDING DR APT 333
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City | FORT WORTH
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State | TX
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Zip | 76131-2192
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Country | US
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Telephone | 347-497-9757
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61270765
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 79317
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License Number State | NM
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