Provider Demographics
NPI:1780690354
Name:EAVES, SUSETTE (CFNP)
Entity Type:Individual
Prefix:
First Name:SUSETTE
Middle Name:
Last Name:EAVES
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 CANDELARIA RD NW
Mailing Address - Street 2:MSC09 5040
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2767
Mailing Address - Country:US
Mailing Address - Phone:505-272-2158
Mailing Address - Fax:
Practice Address - Street 1:1231 CANDELARIA RD NW
Practice Address - Street 2:M-I/FAMILY HEALTH, NW VALLEY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2767
Practice Address - Country:US
Practice Address - Phone:505-272-2158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR21501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine