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General NPI Number Information
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NPI Number | 1275598849
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Entity Type | Individual
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Provider Name | SUE A CRESSEL FNP
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Gender | Female
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2534 MENDOTA RD
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City | MENDOTA
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State | VA
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Zip | 24270-2018
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Country | US
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Telephone | 276-645-6710
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Fax | 276-645-6712
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Provider Business Mailing Address
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Address Line | 999 EXECUTIVE PARK BLVD SUITE 201
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City | KINGSPORT
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State | TN
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Zip | 37660-4632
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Country | US
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Telephone | 423-224-3250
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Fax | 423-224-3258
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5784
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024062526
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License Number State | VA
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