Provider Demographics
NPI:1588670798
Name:ASHTON, SUSAN E (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:ASHTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7531
Mailing Address - Country:US
Mailing Address - Phone:253-848-2303
Mailing Address - Fax:253-848-8956
Practice Address - Street 1:1910 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7531
Practice Address - Country:US
Practice Address - Phone:253-848-2303
Practice Address - Fax:253-848-8956
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001465363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9602012Medicaid