Provider Demographics
NPI:1265958979
Name:CHESEMAN, SUSAN DIANNE (BUSINESS LISCENSE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANNE
Last Name:CHESEMAN
Suffix:
Gender:F
Credentials:BUSINESS LISCENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WINDSOR PINES WAY APT G
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1943
Mailing Address - Country:US
Mailing Address - Phone:757-327-2569
Mailing Address - Fax:757-877-3333
Practice Address - Street 1:121 WINDSOR PINES WAY APT G
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-1943
Practice Address - Country:US
Practice Address - Phone:757-327-2569
Practice Address - Fax:757-877-3333
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA095624-2017251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage