Provider Demographics
NPI:1659557478
Name:AMONDSON, SUSAN JEAN (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:AMONDSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 COOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9047
Mailing Address - Country:US
Mailing Address - Phone:360-827-8100
Mailing Address - Fax:360-736-4952
Practice Address - Street 1:1720 COOKS HILL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9047
Practice Address - Country:US
Practice Address - Phone:360-736-1195
Practice Address - Fax:360-736-4952
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00061022163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical