Provider Demographics
NPI:1114905585
Name:BLICK, SUSAN KATHERINE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KATHERINE
Last Name:BLICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:KATHERINE
Other - Last Name:BLICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2900 LAMB CIR STE 7-700A
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6344
Mailing Address - Country:US
Mailing Address - Phone:540-731-7460
Mailing Address - Fax:540-731-1081
Practice Address - Street 1:2900 LAMB CIR STE 7-700A
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-731-7460
Practice Address - Fax:540-731-1081
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143856363LF0000X
VA0024174390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN143856 NPOtherLICENSE
GA000964554BMedicaid
GA50BBJHVMedicare PIN
GARN143856 NPOtherLICENSE