Provider Demographics
NPI:1346476439
Name:BOERGER, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 SW ANDOVER ST
Mailing Address - Street 2:#D-120
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1153
Mailing Address - Country:US
Mailing Address - Phone:206-923-6300
Mailing Address - Fax:
Practice Address - Street 1:2414 SW ANDOVER ST
Practice Address - Street 2:#D-120
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1153
Practice Address - Country:US
Practice Address - Phone:206-923-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60039406163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health