MEDICARE: MRS. SUSAN W DONCKERS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0024038239	VA

General Provider Information

NPI Number	:	1326078080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN W DONCKERS FNP

Provider Business Mailing Address
First Line	:	4903 STARKEY RD
Second Line	:	SUITE 300
City	:	ROANOKE
State	:	VA
Zip	:	24018
Country	:	US
Telephone Number	:	540-776-7630
Fax Number	:	540-776-7631

Provider Business Practice Location Address
First Line	:	4903 STARKEY RD
Second Line	:	SUITE 300
City	:	ROANOKE
State	:	VA
Zip	:	24018
Country	:	US
Telephone Number	:	540-776-7630
Fax Number	:	540-776-7631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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