Provider Demographics
NPI:1659335347
Name:CORCORAN, SUZAN MORGAN I (ARNP)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:MORGAN
Last Name:CORCORAN
Suffix:I
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5901 N LIDGERWOOD ST
Mailing Address - Street 2:#126
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1122
Mailing Address - Country:US
Mailing Address - Phone:509-489-5110
Mailing Address - Fax:509-489-2850
Practice Address - Street 1:5901 N LIDGERWOOD ST
Practice Address - Street 2:#126
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1122
Practice Address - Country:US
Practice Address - Phone:509-489-5110
Practice Address - Fax:509-489-2850
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003710363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9636747Medicaid