MEDICARE: MRS. SUZZETTE A CAMERON-MOORE NP

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	363LF0000X	Family Nurse Practitioner	0024174534	VA
2	363LF0000X	Family Nurse Practitioner	RN192249	GA

General Provider Information

NPI Number	:	1881044758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZZETTE A CAMERON-MOORE NP

Provider Business Mailing Address
First Line	:	1201 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23249-0001
Country	:	US
Telephone Number	:	804-675-5272
Fax Number	:	804-675-5472

Provider Business Practice Location Address
First Line	:	1201 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23249-8606
Country	:	US
Telephone Number	:	804-675-5272
Fax Number	:	804-675-5472

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

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	11/30/2021

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