Healthcare Provider Details

I. General information

NPI: 1821623562
Provider Name (Legal Business Name): SUZIE ANN YAMAMOTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

PO BOX 84788
SEATTLE WA
98124-6088
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-0930
  • Fax: 206-323-0933
Mailing address:
  • Phone: 206-406-6057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00084047
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: