Provider Demographics
NPI:1760597165
Name:FELIX, SUE (LMP, GCFP)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:FELIX
Suffix:
Gender:F
Credentials:LMP, GCFP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:FELIX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP, GCFP
Mailing Address - Street 1:1730 SE MULLENIX RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9509
Mailing Address - Country:US
Mailing Address - Phone:360-876-9749
Mailing Address - Fax:360-876-9749
Practice Address - Street 1:1730 SE MULLENIX RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9509
Practice Address - Country:US
Practice Address - Phone:360-876-9749
Practice Address - Fax:360-876-9749
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist