Healthcare Provider Details

I. General information

NPI: 1013699842
Provider Name (Legal Business Name): ELIZABETH BLAIR NEWMAN SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SW 43RD ST STE 140
RENTON WA
98057-4803
US

IV. Provider business mailing address

1412 SW 43RD ST STE 140
RENTON WA
98057-4803
US

V. Phone/Fax

Practice location:
  • Phone: 425-264-0750
  • Fax: 425-264-0799
Mailing address:
  • Phone: 425-264-0750
  • Fax: 425-264-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: