1952722241 NPI number — SUSAN PUTAANSUU, MN, ARNP, PLLC

Table of content: (NPI 1952722241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952722241 NPI number — SUSAN PUTAANSUU, MN, ARNP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN PUTAANSUU, MN, ARNP, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1952722241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 SIDNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98366-4541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-459-3808
Provider Business Mailing Address Fax Number:
360-602-0356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 POTTERY AVE
Provider Second Line Business Practice Location Address:
SUITE 134
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-2592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-602-0355
Provider Business Practice Location Address Fax Number:
360-602-0356
Provider Enumeration Date:
01/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PUTAANSUU
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PSYCHIATRIC NURSE PRACTITIONER
Authorized Official Telephone Number:
360-602-0355

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  AP60249845 , 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)





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