Provider Demographics
NPI:1942209085
Name:DEVINE, SUZANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:SUZANNE
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4320 SEMINARY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1535
Mailing Address - Country:US
Mailing Address - Phone:703-504-3789
Mailing Address - Fax:703-504-3556
Practice Address - Street 1:4320 SEMINARY RD
Practice Address - Street 2:INOVA ALEXANDRIA HOSPITAL
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:703-504-3789
Practice Address - Fax:703-504-3556
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001151662367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC003226F89Medicare PIN