MEDICARE: SUSAN L AMES R.N.

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	163WD0400X	Diabetes Educator Registered Nurse	189329	TX
2	163WW0000X	Wound Care Registered Nurse	189329	TX

General Provider Information

NPI Number	:	1760787592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L AMES R.N.

Provider Business Mailing Address
First Line	:	18215 TRAIL WEST DR
Second Line	:
City	:	BUENA VISTA
State	:	CO
Zip	:	81211-9130
Country	:	US
Telephone Number	:	719-395-5839
Fax Number	:

Provider Business Practice Location Address
First Line	:	18215 TRAIL WEST DR
Second Line	:
City	:	BUENA VISTA
State	:	CO
Zip	:	81211-9130
Country	:	US
Telephone Number	:	719-395-5839
Fax Number	:

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

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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Directions to “ SUSAN L AMES R.N.” Practice Location

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