Provider Demographics
NPI:1598845018
Name:WATANABE, SUZAN JEANNE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:JEANNE
Last Name:WATANABE
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 1:11919 NE 128TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7204
Mailing Address - Country:US
Mailing Address - Phone:425-899-5600
Mailing Address - Fax:425-899-5603
Practice Address - Street 1:11919 NE 128TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7204
Practice Address - Country:US
Practice Address - Phone:425-899-5600
Practice Address - Fax:425-899-5603
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 30000483363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9606690Medicaid
WAWA3359OtherREGENCE
WA9606690Medicaid
WAS67311Medicare UPIN