Healthcare Provider Details

I. General information

NPI: 1962493684
Provider Name (Legal Business Name): VALERIE HOPE SLOCUM SUTHERLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5713 WOLLOCHET DR NW STE 101
GIG HARBOR WA
98335-7371
US

IV. Provider business mailing address

PO BOX 21150
BOULDER CO
80308-4150
US

V. Phone/Fax

Practice location:
  • Phone: 253-319-3339
  • Fax: 706-416-4727
Mailing address:
  • Phone: 303-546-9158
  • Fax: 303-546-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberMD00048999
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00048999
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: