MEDICARE: SUSANNE WIEAND 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
1	163WP1700X	Perinatal Registered Nurse	RN00084762	WA

General Provider Information

NPI Number	:	1801267273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNE WIEAND RN

Provider Business Mailing Address
First Line	:	4347 SW CONCORD ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2433
Country	:	US
Telephone Number	:	206-299-1915
Fax Number	:	206-299-1977

Provider Business Practice Location Address
First Line	:	2101 E YESLER WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-5959
Country	:	US
Telephone Number	:	206-299-1915
Fax Number	:	206-299-1977

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

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	10/12/2015

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