Provider Demographics
NPI:1124210612
Name:MINER, SUZANNE M (PAC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:MINER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:HUMPHRYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:14239 W BELL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2470
Mailing Address - Country:US
Mailing Address - Phone:425-654-1275
Mailing Address - Fax:425-654-0539
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:SUITE 301A
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-654-1275
Practice Address - Fax:425-654-0539
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant