Healthcare Provider Details

I. General information

NPI: 1457401333
Provider Name (Legal Business Name): SUSAN NEWSOME LUNDY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD 118(S)
SALEM VA
24153-6404
US

IV. Provider business mailing address

2309 PEPPERS FERRY RD
PULASKI VA
24301-3023
US

V. Phone/Fax

Practice location:
  • Phone: 540-855-3405
  • Fax: 540-224-1983
Mailing address:
  • Phone: 540-980-7172
  • Fax: 540-980-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0001093837
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: