Provider Demographics
NPI:1578805727
Name:VEGA, SUSANA M (CNM)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:M
Last Name:VEGA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 CREST RIVER LN
Mailing Address - Street 2:
Mailing Address - City:AMISSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20106-3405
Mailing Address - Country:US
Mailing Address - Phone:443-955-8185
Mailing Address - Fax:
Practice Address - Street 1:9171 KEY COMMONS CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5300
Practice Address - Country:US
Practice Address - Phone:703-330-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170701367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife