Provider Demographics
NPI:1629011788
Name:EASTMAN, SUSAN M (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:EASTMAN
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 1:100 3RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9730
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:EAST 115 BROADWAY
Practice Address - Street 2:
Practice Address - City:REARDAN
Practice Address - State:WA
Practice Address - Zip Code:99029-0629
Practice Address - Country:US
Practice Address - Phone:509-796-2737
Practice Address - Fax:509-796-2738
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00049615163W00000X
WAAP30000282363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACJ6525OtherMEDICARE RAILROAD
WA9600123Medicaid
WA142721OtherDEPT. OF L & I
WA7101132Medicaid
WA500023044OtherMEDICARE RAILROAD
WA7117450Medicaid
WA7117450Medicaid
ME0082999OtherDEA
WA7101132Medicaid
AB16800Medicare ID - Type Unspecified
WA508528Medicare Oscar/Certification
WAGAB16799Medicare PIN