Individual
SUSAN TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-4001
(703) 776-7113
Mailing address
8406 CROSSLAKE DR, FAIRFAX STATION, VA 22039-2668
(719) 331-3892
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024183754
VA
Other
Enumeration date
03/15/2022
Last updated
03/20/2023
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