Provider Demographics
NPI:1699866392
Name:THOMAS, SUSAN (MS, CRNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2992
Mailing Address - Country:US
Mailing Address - Phone:703-818-3898
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:EAGLE BLDG E2-209
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-0003
Practice Address - Country:US
Practice Address - Phone:571-231-2117
Practice Address - Fax:571-231-6612
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN58917363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCVAD 000Medicare UPIN