Basic Information
| Provider Information | |||||||||
| NPI: | 1902899420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FURR | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17334 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212971334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034436717 | ||||||||
| FaxNumber: | 7034438643 | ||||||||
| Practice Location | |||||||||
| Address1: | 17336 PICKWICK DR | ||||||||
| Address2: | BLDG A SUITE 100 | ||||||||
| City: | PURCELLVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201326179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403389896 | ||||||||
| FaxNumber: | 5403388235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024164289 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1902899420 | 05 | VA | MEDICAID | CG8678 | 01 | VA | RR MEDICARE GROUP PIN | OTHER |