Provider Demographics
NPI:1043383508
Name:BATES, SUSAN FLANIGAN (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FLANIGAN
Last Name:BATES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 SADDLEBACK DR
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-7732
Mailing Address - Country:US
Mailing Address - Phone:970-264-0877
Mailing Address - Fax:
Practice Address - Street 1:MCMWTC BLDG 3005
Practice Address - Street 2:HC 83 BOX 1
Practice Address - City:BRIDGEPORT
Practice Address - State:CA
Practice Address - Zip Code:93517
Practice Address - Country:US
Practice Address - Phone:760-932-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily