Provider Demographics
NPI:1497145304
Name:COLSON, SUSAN ANITA (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANITA
Last Name:COLSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17641 153RD WAY SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-9153
Mailing Address - Country:US
Mailing Address - Phone:360-480-0056
Mailing Address - Fax:
Practice Address - Street 1:17641 153RD WAY SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9153
Practice Address - Country:US
Practice Address - Phone:360-480-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60332834164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse