Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 0024165070 | VA |
NPI | 1154614048 |
---|---|
Provider Name | Mrs. Susan G Magenheimer |
First Address | Leesburg, VA 20176-2704 |
Second Address | Leesburg, VA 20176-8102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 15/05/2020 |