Provider Demographics
NPI:1457401333
Name:LUNDY, SUSAN NEWSOME (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NEWSOME
Last Name:LUNDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 PEPPERS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-3023
Mailing Address - Country:US
Mailing Address - Phone:540-980-7172
Mailing Address - Fax:540-980-7172
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:118(S)
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-855-3405
Practice Address - Fax:540-224-1983
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001093837163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator