Healthcare Provider Details

I. General information

NPI: 1205048717
Provider Name (Legal Business Name): SUSAN WOYNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 WESTERN AVE STE 340
SEATTLE WA
98121-2162
US

IV. Provider business mailing address

2003 WESTERN AVE STE 340
SEATTLE WA
98121-2162
US

V. Phone/Fax

Practice location:
  • Phone: 206-650-2037
  • Fax:
Mailing address:
  • Phone: 206-650-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD 32158
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: