Provider Demographics
NPI:1184812760
Name:HOUCK, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HOUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E STREET NW
Mailing Address - Street 2:US DEPT OF STATE M/MED/QI
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20522-0102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 E STREET NW
Practice Address - Street 2:US DEPT OF STATE M/MED/QI
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0102
Practice Address - Country:US
Practice Address - Phone:703-875-4844
Practice Address - Fax:202-663-1613
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024147337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily