Healthcare Provider Details

I. General information

NPI: 1407914450
Provider Name (Legal Business Name): SUZETTE MARIE GAGNON-BAILEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 6TH AVE STE 200
TACOMA WA
98405-4682
US

IV. Provider business mailing address

915 6TH AVE STE 200
TACOMA WA
98405-4682
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-7299
  • Fax: 253-403-7298
Mailing address:
  • Phone: 253-403-7299
  • Fax: 253-403-4348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30006799
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License NumberAP30006799
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAP30006799
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN00097176
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: