Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024171213 | VA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | R147912 | MD |
NPI | 1649519539 |
---|---|
Provider Name | Mrs. Susan Marie Phelps |
First Address | Falls Church, VA 22042-3300 |
Second Address | Falls Church, VA 22042-3300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2013 |
Last Update Date | 21/09/2020 |