Provider Demographics
NPI:1104842947
Name:HIGHTOWER, SUSAN R (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:HIGHTOWER
Suffix:
Gender:F
Credentials:ARNP
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 5371
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-0371
Mailing Address - Country:US
Mailing Address - Phone:206-987-4445
Mailing Address - Fax:206-987-3839
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-4445
Practice Address - Fax:206-987-3839
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005969363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9635582Medicaid
WAQ25781Medicare UPIN