Healthcare Provider Details

I. General information

NPI: 1942583372
Provider Name (Legal Business Name): SUZAN LYNN DULA PSYD, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 PACIFIC AVE N
LONG BEACH WA
98631-3300
US

IV. Provider business mailing address

905 W RIVERSIDE AVE STE 208
SPOKANE WA
99201-1099
US

V. Phone/Fax

Practice location:
  • Phone: 360-642-3787
  • Fax: 360-642-2096
Mailing address:
  • Phone: 509-747-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10002915
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60420557
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: