Basic Information
| Provider Information | |||||||||
| NPI: | 1295726206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUGGS | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | REGIONAL ADMIN OFFICE | ||||||||
| Address2: | 3411 N 5TH AVE., STE. 209 | ||||||||
| City: | PHOENIX | ||||||||
| State: | NM | ||||||||
| PostalCode: | 850133812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027890344 | ||||||||
| FaxNumber: | 6027898389 | ||||||||
| Practice Location | |||||||||
| Address1: | REGIONAL ADMIN OFFICE | ||||||||
| Address2: | 3411 N 5TH AVE., STE. 209 | ||||||||
| City: | PHOENIX | ||||||||
| State: | NM | ||||||||
| PostalCode: | 850133812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027890344 | ||||||||
| FaxNumber: | 6027898389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R23249 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | CNP00403 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | G3296 | 05 | NM | MEDICAID | 00NM026398 | 01 | NM | BCBS | OTHER |