Provider Demographics
NPI:1235396649
Name:WHITEHURST-DOSS, SUE (FNP)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:WHITEHURST-DOSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024107590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10124300NOtherOPTIMA HEALTH
VA1235396649Medicaid
NC1235396649Medicaid
VA-028OtherTRICARE/CHAMPUS
VAPAROtherMULTIPLAN
VAPAROtherCORVEL
VAP01378958Medicare PIN
VAVVD051AMedicare PIN
VA1235396649OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherUSA MANAGED CARE