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General NPI Number Information
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NPI Number | 1275529570
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Entity Type | Individual
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Provider Name | SUZANNE MARIE WALL N.P.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | BLDG 1806 BRANCH MEDICAL CLINIC NAVAL WEAPONS STATION
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City | YORKTOWN
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State | VA
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Zip | 23691
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Country | US
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Telephone | 757-953-8430
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Fax | 757-953-8450
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Provider Business Mailing Address
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Address Line | PO BOX 90 NAVAL WEAPONS STATION
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City | YORKTOWN
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State | VA
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Zip | 23690-0090
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Country | US
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Telephone | 757-953-8430
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Fax | 757-953-8450
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024165072
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License Number State | VA
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