Provider Demographics
NPI:1376743013
Name:DENNEHY, SUZANNE LISA (CNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LISA
Last Name:DENNEHY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:LISA
Other - Last Name:DENNEHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:125 EL PASO RD
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6033
Mailing Address - Country:US
Mailing Address - Phone:575-630-8350
Mailing Address - Fax:575-257-2153
Practice Address - Street 1:125 EL PASO RD
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6033
Practice Address - Country:US
Practice Address - Phone:575-630-8350
Practice Address - Fax:575-257-2153
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00522363LF0000X
NMR27375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily