SUSAN R WATERBURY (NPI# 1508824699) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508824699 |
| Entity Type | Individual |
| Full Name | SUSAN R WATERBURY |
| Credential | FNP-BC, ACHPN |
| Practice Address |
11212 Waples Mill Rd Suite 100 Fairfax VA 22030 |
| Practice Telephone | 5713081900 |
| Practice Fax Number | 5713081919 |
| Mailing Telephone | 5713081900 |
| Mailing Fax Number | 5713081919 |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2015-05-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 314100168 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
0001251055 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 303783500 | 05 |
| Street Address |
11212 WAPLES MILL RD SUITE 100 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033577184 | O&o Alpan, LLC | Pharmacy | 11212 Waples Mill Rd, Suite 100, Fairfax, VA 22030-7404 | 2016-02-03 |
| 1205238383 | Amerimmune LLC | Clinical Medical Laboratory | 11212 Waples Mill Rd, Suite 100, Fairfax, VA 22030-7404 | 2014-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144147 | Emily Turner | Nurse Practitioner | 1099 Main St, Fairfax, VT 05454-9529 | 2020-11-06 |
| 1366041790 | Stephanie Ferber | Nurse Practitioner | 8081 Innovation Park Dr Fl 7, Fairfax, VA 22031-4867 | 2020-10-16 |
| 1578160198 | Northern Virginia Holistic Primary Care | Nurse Practitioner | 10304 Eaton Pl Ste 100, Fairfax, VA 22030-2238 | 2020-10-06 |
| 1821606377 | Lindsay Ann Bruno | Nurse Practitioner | 2921 District Ave Apt 504, Fairfax, VA 22031-2334 | 2020-07-21 |
| 1013534106 | Natalia Castro | Nurse Practitioner | 12817 Hamlet Hill Way, Fairfax, VA 22030-7250 | 2020-07-06 |
| 1629601448 | Lia Hoa Van | Nurse Practitioner | 3811 Glenbrook Rd, Fairfax, VA 22031-3105 | 2020-02-20 |
| 1043850175 | Olga Michelle Zaiter | Nurse Practitioner | 2740 Prosperity Ave Ste 100, Fairfax, VA 22031-4354 | 2020-01-07 |
| 1821650177 | Evelyne Kingori | Nurse Practitioner | 3022 Javier Rd Ste 105a, Fairfax, VA 22031-4646 | 2019-07-07 |
| 1770149726 | Laura E. Diaz | Nurse Practitioner | 3923 Old Lee Hwy Ste 61a, Fairfax, VA 22030-2428 | 2019-05-15 |
| 1295253102 | Mildred J Medrano | Nurse Practitioner | 9229 Arlington Arlington Blvd., Fairfax, VA 22031 | 2017-08-31 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.