Provider Demographics
NPI:1376504381
Name:MEADER, SUZANNE A (ARNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:A
Last Name:MEADER
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 3905
Mailing Address - Street 2:DEPT. 4204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3905
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-2369
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 605
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-454-8161
Practice Address - Fax:425-454-9304
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP0004332363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0133985OtherL & I WORKERS COMP.
WA9626334Medicaid
WAME5737OtherREGENCE BLUESHIELD RIDER
WAAB14947Medicare ID - Type Unspecified
WA9626334Medicaid