Provider Demographics
NPI:1437575982
Name:SUZETTE GURTISEN, LMP
Entity Type:Organization
Organization Name:SUZETTE GURTISEN, LMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:JANA
Authorized Official - Last Name:GURTISEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:509-778-1271
Mailing Address - Street 1:4763 POPPY ST
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-7770
Mailing Address - Country:US
Mailing Address - Phone:509-778-1271
Mailing Address - Fax:
Practice Address - Street 1:4763 POPPY ST
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-7770
Practice Address - Country:US
Practice Address - Phone:509-778-1271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60024946273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60024946OtherLMP