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NPI Code Detail

MEDICARE: SUSAN C CREEKMORE APRN-BC

MEDICARE:   SUSAN C CREEKMORE  APRN-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner0024093376VA

General Provider Information

NPI Number : 1376779314
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN C CREEKMORE APRN-BC
Provider Business Mailing Address
First Line : 2128 PROFFITT ROAD
Second Line :
City : MANAKIN SABOT
State : VA
Zip : 23103-2211
Country : US
Telephone Number : 804-749-4458
Fax Number :
Provider Business Practice Location Address
First Line : 2125 HILLARD ROAD
Second Line :
City : RICHMOND
State : VA
Zip : 23228-4600
Country : US
Telephone Number : 419-531-2127
Fax Number : 419-531-2664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2009
Last Update Date : 06/04/2009

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Directions to “ SUSAN C CREEKMORE APRN-BC” Practice Location

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