Doctor Name: | MS. SUZANNE MARIE WALL |
NPI Number: | 1275529570 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | 0024165072 |
Business Practice Address: | Bldg 1806 Branch Medical Clinic Naval Weapons Station Yorktown, VA - 23691 |
Business Phone Number: | 7579538430 |
Business Fax Number: | 7579538450 |
Mailing Address: | Po Box 90, Naval Weapons Station YORKTOWN |
State: | VA |
Postal Code: | 236900090 |
Phone Number: | 7579538430 |
Fax Number: | 7579538450 |
NPI Enumeration Date: | 09/22/2005 |
NPI Last Update Date: | 11/15/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024165072 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |