Provider Demographics
NPI:1831194117
Name:OBRIEN, SUZANNE (CFNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:O'BRIEN
Other - Last Name:SACHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFNP
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:46440 BENEDICT DR
Practice Address - Street 2:STE 207
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6602
Practice Address - Country:US
Practice Address - Phone:703-444-2100
Practice Address - Fax:703-444-0386
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024131558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1831194117Medicaid