Healthcare Provider Details

I. General information

NPI: 1194746768
Provider Name (Legal Business Name): SUSAN M VINEBERG RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 43RD AVE S
SEATTLE WA
98118-2306
US

IV. Provider business mailing address

5028 43RD AVE S
SEATTLE WA
98118-2306
US

V. Phone/Fax

Practice location:
  • Phone: 206-999-8428
  • Fax:
Mailing address:
  • Phone: 206-999-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number00101365
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN00101365
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code364SP2800X
TaxonomyPerioperative Clinical Nurse Specialist
License Number00101365
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code364SP2800X
TaxonomyPerioperative Clinical Nurse Specialist
License NumberRN00101365
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: