Provider Demographics
NPI:1710222567
Name:PAUL, SUZANNE MCCONNELL (NP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MCCONNELL
Last Name:PAUL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MCCONNELL
Other - Last Name:EGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:25892 NORTH JAMES MADISON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEW CANTON
Mailing Address - State:VA
Mailing Address - Zip Code:23123-0220
Mailing Address - Country:US
Mailing Address - Phone:434-581-3271
Mailing Address - Fax:434-581-1105
Practice Address - Street 1:25892 NORTH JAMES MADISON HIGHWAY
Practice Address - Street 2:
Practice Address - City:NEW CANTON
Practice Address - State:VA
Practice Address - Zip Code:23123-0220
Practice Address - Country:US
Practice Address - Phone:434-581-3271
Practice Address - Fax:434-581-1105
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily