Provider Demographics
NPI:1619043908
Name:LANSBURY, SUSAN LESLIE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LESLIE
Last Name:LANSBURY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 EXECUTIVE CENTER PKWY
Mailing Address - Street 2:SUITE #106
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3177
Mailing Address - Country:US
Mailing Address - Phone:540-899-3440
Mailing Address - Fax:540-899-3434
Practice Address - Street 1:200 EXECUTIVE CENTER PKWY
Practice Address - Street 2:SUITE #106
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3177
Practice Address - Country:US
Practice Address - Phone:540-899-3440
Practice Address - Fax:540-899-3434
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA002410447363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
0086442M92Medicare ID - Type Unspecified
P46199Medicare UPIN