Provider Demographics
NPI:1366286940
Name:HUNTSMAN, SUZANNE MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:HUNTSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MICHELLE
Other - Last Name:TOLLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 GOLF COURSE RD SE STE 203
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4731
Mailing Address - Country:US
Mailing Address - Phone:505-225-7040
Mailing Address - Fax:505-225-7028
Practice Address - Street 1:1101 GOLF COURSE RD SE STE 203
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4731
Practice Address - Country:US
Practice Address - Phone:505-225-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81067363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily