Provider Demographics
NPI:1497733620
Name:STONE, SUSAN E (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:STONE
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 1:1120 112TH AVE NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4500
Mailing Address - Country:US
Mailing Address - Phone:426-467-3978
Mailing Address - Fax:425-688-5281
Practice Address - Street 1:1120 112TH AVE NE
Practice Address - Street 2:SUITE 150
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4500
Practice Address - Country:US
Practice Address - Phone:425-467-3978
Practice Address - Fax:425-688-5281
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006079363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0222788OtherLIWA
WA4648STOtherBSWA
WA9647496Medicaid
WA0222787OtherLIWA
WA6751STOtherBSWA
WA4648STOtherBSWA
WA9647496Medicaid
WAG8866515Medicare UPIN