Provider Demographics
NPI:1851402622
Name:CAVERLY, SUSAN ELIZABETH (PHD,ARNP,MA,BC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:CAVERLY
Suffix:
Gender:F
Credentials:PHD,ARNP,MA,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-1325
Mailing Address - Country:US
Mailing Address - Phone:206-369-3068
Mailing Address - Fax:
Practice Address - Street 1:144 E JOHNSON AVE UNIT 1325
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9484
Practice Address - Country:US
Practice Address - Phone:206-369-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000933163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9605916Medicaid
WAS66475Medicare UPIN