MEDICARE: KONNIE S SUTHER L.AC.

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
1	171100000X	Acupuncturist	2690	WA

General Provider Information

NPI Number	:	1598978637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KONNIE S SUTHER L.AC.

Provider Business Mailing Address
First Line	:	4000 NE 41ST ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-5428
Country	:	US
Telephone Number	:	206-218-7440
Fax Number	:	206-342-3825

Provider Business Practice Location Address
First Line	:	4000 NE 41ST ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-5428
Country	:	US
Telephone Number	:	206-218-7440
Fax Number	:	206-342-3825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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Directions to “ KONNIE S SUTHER L.AC.” Practice Location

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