Healthcare Provider Details

I. General information

NPI: 1811550064
Provider Name (Legal Business Name): SUZANNE QUEHEILLALT CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JEFFERSON PARK AVE FL 4
CHARLOTTESVILLE VA
22903-3363
US

IV. Provider business mailing address

1300 JEFFERSON PARK AVE FL 4
CHARLOTTESVILLE VA
22903-3363
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0024181963
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0015000944
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: