Provider Demographics
NPI:1659724193
Name:SUHARLI, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:SUHARLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:SUHARLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-0382
Mailing Address - Country:US
Mailing Address - Phone:505-288-4470
Mailing Address - Fax:
Practice Address - Street 1:1901 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3303
Practice Address - Country:US
Practice Address - Phone:505-262-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP02990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily