Provider Demographics
NPI:1225192511
Name:WILLIAMS-ROSENTHAL, SUZANN (GNP)
Entity type:Individual
Prefix:
First Name:SUZANN
Middle Name:
Last Name:WILLIAMS-ROSENTHAL
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LEE ST
Mailing Address - Street 2:BOX 800566
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0566
Mailing Address - Country:US
Mailing Address - Phone:434-924-5689
Mailing Address - Fax:434-243-2823
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:BOX 800566
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0566
Practice Address - Country:US
Practice Address - Phone:434-924-5689
Practice Address - Fax:434-243-2823
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166637363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVB937AMedicare PIN