=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427128578
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN LYNN GINS C.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 09/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2915 E. MADISON STREET #208
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-795-8892
-----------------------------------------------------
Fax | 425-483-6334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6830 NE BOTHELL WAY C392
-----------------------------------------------------
City | KENMORE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-794-8892
-----------------------------------------------------
Fax | 425-483-6334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | NU00001017
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------