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NPI Code Detail

MEDICARE: SUZANNE E PORTER RN

MEDICARE: SUZANNE E PORTER RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN60317587WA

General Provider Information

NPI Number : 1073958294
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUZANNE E PORTER RN
Provider Business Mailing Address
First Line : 2445 THIRD AVE. SOUTH
Second Line : SPS STUDENT HEALTH SERVICES
City : SEATTLE
State : WA
Zip : 98134
Country : US
Telephone Number : 206-252-0750
Fax Number :
Provider Business Practice Location Address
First Line : 2600 SW THISTLE ST
Second Line : CHIEF SEALTH HIGH SCHOOL
City : SEATTLE
State : WA
Zip : 98126-3748
Country : US
Telephone Number : 206-252-0750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2013
Last Update Date : 05/01/2013

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