Healthcare Provider Details

I. General information

NPI: 1861304321
Provider Name (Legal Business Name): SUZANA TRIFUNOVIC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 112TH AVE NE BUILDING C, SUITE 115
VELLEVUE WA
98004
US

IV. Provider business mailing address

13305 NE 171ST ST APT G245
WOODINVILLE WA
98072-6918
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-0244
  • Fax: 425-455-0244
Mailing address:
  • Phone: 425-455-0244
  • Fax: 425-455-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61294704
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: