Healthcare Provider Details

I. General information

NPI: 1972055457
Provider Name (Legal Business Name): DEBORAH VICTORIA SUCHMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 M ST NW
WASHINGTON DC
20001-1205
US

IV. Provider business mailing address

1150 VARNUM ST NE FL HALL1
WASHINGTON DC
20017-2104
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-3840
  • Fax: 202-854-3854
Mailing address:
  • Phone: 202-854-4812
  • Fax: 202-854-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR224652
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1022520
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN1022520
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: