Provider Demographics
NPI:1023337714
Name:NICKEL, SUZANNE LYNNE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:LYNNE
Last Name:NICKEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 CHURCHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5205
Mailing Address - Country:US
Mailing Address - Phone:757-484-7822
Mailing Address - Fax:757-484-7362
Practice Address - Street 1:3205 CHURCHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5205
Practice Address - Country:US
Practice Address - Phone:757-484-7822
Practice Address - Fax:757-484-7362
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily