Healthcare Provider Details

I. General information

NPI: 1487895256
Provider Name (Legal Business Name): SUE ANNETTE SLADE PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNETTE SPELLMAN SLADE PNP-BC

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

PO BOX 79137
BALTIMORE MD
21279-0137
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7243
  • Fax: 757-668-7811
Mailing address:
  • Phone: 757-668-7200
  • Fax: 757-668-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024165814
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: