Provider Demographics
NPI:1013978006
Name:BANKS, SUSAN KAY (CNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:BANKS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINAIR
Mailing Address - State:NM
Mailing Address - Zip Code:87036-0787
Mailing Address - Country:US
Mailing Address - Phone:505-847-2271
Mailing Address - Fax:
Practice Address - Street 1:105 EAST PINON STREET
Practice Address - Street 2:
Practice Address - City:MOUNTAINAIR
Practice Address - State:NM
Practice Address - Zip Code:87036
Practice Address - Country:US
Practice Address - Phone:505-847-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR22221163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10002813OtherLOVELACE HEALTH PLAN
NM850206810OtherTRICARE
NMPROVP11807OtherMOLINA HEALTHCARE
NM93567Medicaid
NMNM006E47OtherBLUECROSS BLUESHIELD OF NEW MEXICO
NM93567Medicaid
NMPROVP11807OtherMOLINA HEALTHCARE