MEDICARE: SUSAN ERNST WEINER CPNP

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
1	363LP0200X	Pediatric Nurse Practitioner	0024095989	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578557930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ERNST WEINER CPNP

Provider Business Mailing Address
First Line	:	PO BOX 17334
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-1334
Country	:	US
Telephone Number	:	703-443-6717
Fax Number	:	703-443-8643

Provider Business Practice Location Address
First Line	:	20955 PROFESSIONAL PLZ
Second Line	:	STE 200
City	:	ASHBURN
State	:	VA
Zip	:	20147-3405
Country	:	US
Telephone Number	:	703-729-7652
Fax Number	:	703-729-8746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/04/2011

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