Provider Demographics
NPI:1821120841
Name:PIANKO, DOROTHY SUZANNE (FNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:SUZANNE
Last Name:PIANKO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:SUZANNE
Other - Last Name:FRODSHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-7458
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:SUITE 500
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-251-5110
Practice Address - Fax:425-793-7382
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007206363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9514PIOtherREGENCE
WA9659889Medicaid
WAP00676398OtherMED RAILROAD
WA0242193OtherL&I
WAP00676398OtherMED RAILROAD
WAG8877105Medicare PIN