MEDICARE: DR. SUSAN MARIE MCGOWEN PHD, EMT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	274	NM

General Provider Information

NPI Number	:	1386600021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MARIE MCGOWEN PHD, EMT, ATC

Provider Business Mailing Address
First Line	:	8817 CHERRY HILLS RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1030
Country	:	US
Telephone Number	:	505-277-8167
Fax Number	:	505-277-6227

Provider Business Practice Location Address
First Line	:	8817 CHERRY HILLS RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1030
Country	:	US
Telephone Number	:	505-277-8167
Fax Number	:	505-277-6227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/08/2007

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