1639250251 NPI number — DR. SUE ZEE EDMISON ND LM

Table of content: DR. SUE ZEE EDMISON ND LM (NPI 1639250251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639250251 NPI number — DR. SUE ZEE EDMISON ND LM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDMISON
Provider First Name:
SUE
Provider Middle Name:
ZEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ND LM
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:
1639250251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 77038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-957-2015
Provider Business Mailing Address Fax Number:
206-957-2016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12317 15TH NE
Provider Second Line Business Practice Location Address:
S 103
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-957-2015
Provider Business Practice Location Address Fax Number:
206-957-2016
Provider Enumeration Date:
10/18/2006

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: 175F00000X , with the licence number:  NT00000467 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 176B00000X , with the licence number: MW00000105 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 5324ED . This is a "REGENCE INSURANCE FOR ND" identifier . This identifiers is of the category "OTHER".
  • Identifier: ED0111 . This is a "REGENCE INSURANCE FOR LM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7045677 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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