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General NPI Number Information
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NPI Number | 1063505808
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Entity Type | Individual
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Provider Name | SUSAN H. MYZER CPNP
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 4686 POUNCEY TRACT ROAD
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City | GLEN ALLEN
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State | VA
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Zip | 23059
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Country | US
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Telephone | 804-422-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 89 FOREST LN
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City | KING WILLIAM
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State | VA
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Zip | 23086-3527
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Country | US
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Telephone | 480-221-7626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0024172825
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License Number State | VA
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