Provider Demographics
NPI:1124040860
Name:LYLE, SUSAN DEMPSEY (RN BSN MSN APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEMPSEY
Last Name:LYLE
Suffix:
Gender:F
Credentials:RN BSN MSN APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 CHAIN BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-385-9665
Mailing Address - Fax:
Practice Address - Street 1:3950 CHAIN BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-385-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACNS0015000773163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult