Provider Demographics
NPI:1962542464
Name:DE BULLET, SUSAN LINARD (NP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LINARD
Last Name:DE BULLET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-9388
Mailing Address - Country:US
Mailing Address - Phone:540-636-4994
Mailing Address - Fax:540-636-4994
Practice Address - Street 1:1830 TOWN CENTER DR
Practice Address - Street 2:SUITE 303
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3292
Practice Address - Country:US
Practice Address - Phone:703-326-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024088665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily