Provider Demographics
NPI:1881044758
Name:CAMERON-MOORE, SUZZETTE A (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUZZETTE
Middle Name:A
Last Name:CAMERON-MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUZZETTE
Other - Middle Name:A
Other - Last Name:MOSOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 BROAD ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249-0001
Mailing Address - Country:US
Mailing Address - Phone:804-675-5272
Mailing Address - Fax:804-675-5472
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-8606
Practice Address - Country:US
Practice Address - Phone:804-675-5272
Practice Address - Fax:804-675-5472
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174534363LF0000X
GARN192249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily