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General NPI Number Information
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NPI Number | 1366987745
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Entity Type | Individual
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Provider Name | SUSAN DIANNE ANDERSON NP-C
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Gender | Female
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 150 KINGSLEY LN
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City | NORFOLK
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State | VA
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Zip | 23505-4602
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Country | US
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Telephone | 757-889-5180
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Fax |
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Provider Business Mailing Address
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Address Line | 840 HOLLY HEDGE AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6404
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Country | US
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Telephone | 757-395-7469
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024174176
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License Number State | VA
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