Provider Demographics
NPI:1386121648
Name:WASHINGTON, SUSAN DARLENE (RN, MSN, CCM)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DARLENE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:RN, MSN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 SUDLEY RD STE 424
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2886
Mailing Address - Country:US
Mailing Address - Phone:703-420-2712
Mailing Address - Fax:703-420-2716
Practice Address - Street 1:7900 SUDLEY RD STE 424
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2886
Practice Address - Country:US
Practice Address - Phone:703-420-2712
Practice Address - Fax:703-420-2716
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA201803280021353171M00000X, 163WA2000X, 163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health