Provider Demographics
NPI:1598821076
Name:BARRETT, SUSAN (GNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:BARRETT
Other - Last Name:CALVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:682 CALLE ESPEJO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4947
Mailing Address - Country:US
Mailing Address - Phone:505-726-3020
Mailing Address - Fax:
Practice Address - Street 1:1660 OLD PECOS TRL STE G
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4768
Practice Address - Country:US
Practice Address - Phone:505-472-7243
Practice Address - Fax:505-472-7244
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH045900-23364SG0600X
NMCNP-01772207RR0500X, 363LG0600X
MARN204355363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH001965101OtherMEDICARE PTAN
NH30348502Medicaid