Doctor Name: | SUZANNAH RYAN STIVISON |
NPI Number: | 1053686246 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | R193057 |
Business Practice Address: | 8401 Connecticut Ave Suite 201 Chevy Chase, MD - 208155803 |
Business Phone Number: | 3019073690 |
Business Fax Number: | |
Mailing Address: | 8401 Connecticut Ave, Suite 201 CHEVY CHASE |
State: | MD |
Postal Code: | 208155803 |
Phone Number: | 3019073690 |
Fax Number: | |
NPI Enumeration Date: | 03/20/2012 |
NPI Last Update Date: | 03/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | R193057 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |