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General NPI Number Information
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NPI Number | 1699866392
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Entity Type | Individual
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Provider Name | SUSAN THOMAS MSN, CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP EAGLE BLDG E2-209
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City | FORT BELVOIR
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State | VA
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Zip | 22060-0003
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Country | US
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Telephone | 571-231-2117
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Fax | 571-231-6612
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Provider Business Mailing Address
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Address Line | 5626 FLAGLER DR
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City | CENTREVILLE
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State | VA
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Zip | 20120-2992
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Country | US
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Telephone | 571-732-5821
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN58917
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License Number State | DC
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