Provider Demographics
NPI:1033218797
Name:BLADEK, SUZANNE K (APRN, BC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:K
Last Name:BLADEK
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 NW RICHMOND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3101
Mailing Address - Country:US
Mailing Address - Phone:206-546-5181
Mailing Address - Fax:206-546-6575
Practice Address - Street 1:355 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3101
Practice Address - Country:US
Practice Address - Phone:206-546-5181
Practice Address - Fax:206-546-6575
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003959363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9619313Medicaid
WAP00420668OtherRAILROAD MEDICARE
WAS46497Medicare UPIN
WAP00420668OtherRAILROAD MEDICARE