Provider Demographics
NPI:1477805133
Name:ALTMAN, SUSAN JACQUELINE (MN, RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JACQUELINE
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:MN, RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JACQUELINE
Other - Last Name:OBREZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16250 NE 74TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16250 NE 74TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7817
Practice Address - Country:US
Practice Address - Phone:425-702-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00065258163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool