Provider Demographics
NPI:1730519307
Name:VANCE, SUZANNE (DAOM, M AC)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:DAOM, M AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:EARLYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22936-0091
Mailing Address - Country:US
Mailing Address - Phone:434-529-8757
Mailing Address - Fax:
Practice Address - Street 1:233 HYDRAULIC RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8139
Practice Address - Country:US
Practice Address - Phone:434-529-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM227171100000X
171100000X
WV96216171100000X
HI225171100000X
VA0121000389171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist