1497733620 NPI number — SUSAN E STONE ARNP

Table of content: SUSAN E STONE ARNP (NPI 1497733620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497733620 NPI number — SUSAN E STONE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STONE
Provider First Name:
SUSAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497733620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 112TH AVE NE
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
426-467-3978
Provider Business Mailing Address Fax Number:
425-688-5281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 112TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-467-3978
Provider Business Practice Location Address Fax Number:
425-688-5281
Provider Enumeration Date:
01/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  AP30006079 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0222788 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4648ST . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9647496 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0222787 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 6751ST . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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