Provider Demographics
NPI:1023017043
Name:TAYLOR, SUSAN G (RN, ARNP, CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN, ARNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2329
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-7329
Mailing Address - Country:US
Mailing Address - Phone:509-529-9876
Mailing Address - Fax:509-593-5024
Practice Address - Street 1:1020 SAMISH WAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-3104
Practice Address - Country:US
Practice Address - Phone:425-231-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID23815163W00000X
WARN00105586163W00000X
IDRNA-340367500000X
WAAP30005906367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9633538Medicaid
ID1023017043Medicaid
WA1000500Medicaid