Provider Demographics
NPI:1871705053
Name:NETTLETON, SUSAN CORREU (MD MINISTER)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CORREU
Last Name:NETTLETON
Suffix:
Gender:F
Credentials:MD MINISTER
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:CORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:435 JEFFERSON SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108
Mailing Address - Country:US
Mailing Address - Phone:505-254-2606
Mailing Address - Fax:
Practice Address - Street 1:435 JEFFERSON SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-254-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101Y00000X
NM82962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry