Provider Demographics
NPI:1487895256
Name:SLADE, SUE ANNETTE (PNP-BC)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ANNETTE
Last Name:SLADE
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:SPELLMAN
Other - Last Name:SLADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP-BC
Mailing Address - Street 1:PO BOX 79137
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0137
Mailing Address - Country:US
Mailing Address - Phone:757-668-7200
Mailing Address - Fax:757-668-9691
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7243
Practice Address - Fax:757-668-7811
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165814363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics