Healthcare Provider Details

I. General information

NPI: 1841205416
Provider Name (Legal Business Name): SUZANNE BOYER KRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE AUDREY BOYER MD

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 TALBOT RD S STE 460
RENTON WA
98055-5773
US

IV. Provider business mailing address

PO BOX 59028
RENTON WA
98058-2028
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-5110
  • Fax: 425-793-7382
Mailing address:
  • Phone: 425-251-5110
  • Fax: 425-793-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD00037467
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD00037467
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD00037467
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: