Healthcare Provider Details

I. General information

NPI: 1811954829
Provider Name (Legal Business Name): SUSAN E KRANZPILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 PORTAL WAY
FERNDALE WA
98248-7833
US

IV. Provider business mailing address

1616 CORNWALL AVE STE 205
BELLINGHAM WA
98225-4642
US

V. Phone/Fax

Practice location:
  • Phone: 360-676-6177
  • Fax: 360-671-3574
Mailing address:
  • Phone: 360-676-6177
  • Fax: 360-671-5374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC54129
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD27702
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00041782
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: