Provider Demographics
NPI:1215222591
Name:MIREL, SUSANNA R (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:R
Last Name:MIREL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:R
Other - Last Name:MIREL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:971 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2503
Mailing Address - Country:US
Mailing Address - Phone:360-577-1771
Mailing Address - Fax:360-423-1405
Practice Address - Street 1:13451 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1475
Practice Address - Country:US
Practice Address - Phone:425-562-1337
Practice Address - Fax:425-562-1331
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60223340363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics