Provider Demographics
NPI:1235396649
Name:WHITEHURST-DOSS, SUE (FNP)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:WHITEHURST-DOSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 KINGSBOROUGH SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4999
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-819-7185
Practice Address - Street 1:908 EDEN WAY N STE 101
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3336
Practice Address - Country:US
Practice Address - Phone:757-312-6267
Practice Address - Fax:757-819-7185
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024107590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10124300NOtherOPTIMA HEALTH
VA1235396649Medicaid
NC1235396649Medicaid
VA-028OtherTRICARE/CHAMPUS
VAPAROtherMULTIPLAN
VAPAROtherCORVEL
VAP01378958Medicare PIN
VAVVD051AMedicare PIN
VA1235396649OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherUSA MANAGED CARE