Provider Demographics
NPI:1689669533
Name:MCFADDEN, SUSAN EILEEN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:EILEEN
Last Name:MCFADDEN
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 1:105 W 8TH #6020
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204
Mailing Address - Country:US
Mailing Address - Phone:509-455-5050
Mailing Address - Fax:509-747-5391
Practice Address - Street 1:105 W 8TH #6020
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-455-5050
Practice Address - Fax:509-747-5391
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005888207Q00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016343Medicaid
WA9631136Medicaid
WA8861514Medicare PIN
P33723Medicare UPIN
WAAB22509Medicare ID - Type Unspecified