Provider Demographics
NPI:1932155892
Name:BINDEWALD, SUSAN P (APRN, BC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:P
Last Name:BINDEWALD
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:P.O. BOX 1279
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-1279
Mailing Address - Country:US
Mailing Address - Phone:434-836-2260
Mailing Address - Fax:434-836-1783
Practice Address - Street 1:110 HENRY STREET
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-4201
Practice Address - Country:US
Practice Address - Phone:434-836-2260
Practice Address - Fax:434-836-1783
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000157103TC2200X
VA0024181808363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010175372Medicaid
VA00W484W85Medicare ID - Type Unspecified