Provider Demographics
NPI:1902899420
Name:FURR, SUSAN M (CFNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:FURR
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:STE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:43300 SOUTHERN WALK PLAZA, SUITE 100
Practice Address - Street 2:
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-4463
Practice Address - Country:US
Practice Address - Phone:571-252-7353
Practice Address - Fax:571-223-1797
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902899420Medicaid
VACG8678OtherRR MEDICARE GROUP PIN
VA30016112830001Medicaid
VACG8678OtherRR MEDICARE GROUP PIN
VA1902899420Medicaid