Healthcare Provider Details

I. General information

NPI: 1629011788
Provider Name (Legal Business Name): SUSAN M. EASTMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/04/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST 115 BROADWAY
REARDAN WA
99029-0629
US

IV. Provider business mailing address

100 3RD ST SUITE 1
DAVENPORT WA
99122-9730
US

V. Phone/Fax

Practice location:
  • Phone: 509-796-2737
  • Fax: 509-796-2738
Mailing address:
  • Phone: 509-725-7501
  • Fax: 509-725-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30000282
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00049615
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: