Provider Demographics
NPI:1376779314
Name:CREEKMORE, SUSAN C (APRN-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:CREEKMORE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 PROFFITT ROAD
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-2211
Mailing Address - Country:US
Mailing Address - Phone:804-749-4458
Mailing Address - Fax:
Practice Address - Street 1:2125 HILLARD ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-4600
Practice Address - Country:US
Practice Address - Phone:419-531-2127
Practice Address - Fax:419-531-2664
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024093376363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner