Provider Demographics
NPI:1700020286
Name:MOLLOY, SUZANNE BAILEY (CERTIFIED ADULT NURS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BAILEY
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:CERTIFIED ADULT NURS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 UNIVERSITY DRIVE
Mailing Address - Street 2:MSN-2D3 GEORGE MASON UNIVERSITY STUDENT HEALTH SERVICES
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-993-2831
Mailing Address - Fax:703-993-4365
Practice Address - Street 1:4400 UNIVERSITY DRIVE
Practice Address - Street 2:MSN-2D3 GEORGE MASON UNIVERSITY STUDENT HEALTH SERVICES
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-993-2831
Practice Address - Fax:703-993-4365
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017000511363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner