Healthcare Provider Details

I. General information

NPI: 1821120841
Provider Name (Legal Business Name): DOROTHY SUZANNE PIANKO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTHY SUZANNE FRODSHAM FNP

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S SUITE 500
RENTON WA
98055-5772
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: 425-793-7458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30007206
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30007206
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: