Provider Demographics
NPI:1407914450
Name:GAGNON-BAILEY, SUZETTE MARIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:MARIE
Last Name:GAGNON-BAILEY
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 1:915 6TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4682
Mailing Address - Country:US
Mailing Address - Phone:253-403-7299
Mailing Address - Fax:253-403-4348
Practice Address - Street 1:915 6TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4682
Practice Address - Country:US
Practice Address - Phone:253-403-7299
Practice Address - Fax:253-403-7298
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006799363LA2200X, 173F00000X, 174400000X
WARN00097176163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No173F00000XOther Service ProvidersSleep Specialist, PhD
No174400000XOther Service ProvidersSpecialist
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine