Healthcare Provider Details

I. General information

NPI: 1659402808
Provider Name (Legal Business Name): SUZANNE LENORE WAHL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE L SLANEY PA-C

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5000
  • Fax:
Mailing address:
  • Phone: 206-520-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004926
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10004926
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10004926
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: