Healthcare Provider Details

I. General information

NPI: 1073655031
Provider Name (Legal Business Name): SUZANNE LYNN THOMSON LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10357 14TH AVE NW
SEATTLE WA
98177-5303
US

IV. Provider business mailing address

10357 14TH AVE NW
SEATTLE WA
98177-5303
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-5156
  • Fax: 206-362-5344
Mailing address:
  • Phone: 206-365-5156
  • Fax: 206-362-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00000204
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: