Healthcare Provider Details

I. General information

NPI: 1831338094
Provider Name (Legal Business Name): SUSAN KAHLE BABCOCK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 RUCKER AVE SUITE 108
EVERETT WA
98201-3900
US

IV. Provider business mailing address

3020 RUCKER AVE SUITE 108
EVERETT WA
98201-3900
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5220
  • Fax: 425-339-5222
Mailing address:
  • Phone: 425-339-5220
  • Fax: 425-339-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN 00154811
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: