Provider Demographics
NPI:1417068263
Name:RICHARDSON, SUZANNE M (PA C)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1703 S MERIDIAN STE 101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7590
Mailing Address - Country:US
Mailing Address - Phone:253-848-3000
Mailing Address - Fax:253-845-8750
Practice Address - Street 1:11216 SUNRISE BLVD E STE 3-102
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8848
Practice Address - Country:US
Practice Address - Phone:253-848-3000
Practice Address - Fax:253-845-8750
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10004546363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8372955Medicaid
WA8802050Medicare ID - Type Unspecified
WA8372955Medicaid