Provider Demographics
NPI:1679760920
Name:MARRA, SUSAN LYNN (ND)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:MARRA
Suffix:
Gender:F
Credentials:ND
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Mailing Address - Street 1:5322 ROOSEVELT WAY NE
Mailing Address - Street 2:UNIVERSITY HEALTH CLINIC SPECIALITY CARE & RESEARCH CEN
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3629
Mailing Address - Country:US
Mailing Address - Phone:206-525-8012
Mailing Address - Fax:206-525-8013
Practice Address - Street 1:5322 ROOSEVELT WAY NE
Practice Address - Street 2:UNIVERSITY HEALTH CLINIC SPECIALITY CARE & RESEARCH CEN
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3629
Practice Address - Country:US
Practice Address - Phone:206-525-8012
Practice Address - Fax:206-525-8013
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WANT00001579175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
NT00001579OtherND LICENSE NUMBER