Provider Demographics
NPI:1164945127
Name:WORKMAN, SUSAN ANN (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13 W 3RD ST STE 111
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1536
Mailing Address - Country:US
Mailing Address - Phone:719-383-3040
Mailing Address - Fax:719-383-3060
Practice Address - Street 1:13 WEST THIRD STREET, ROOM 111
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050
Practice Address - Country:US
Practice Address - Phone:719-383-3040
Practice Address - Fax:719-383-3060
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0096955364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1881608878Medicaid