Provider Demographics
NPI:1851795439
Name:WARTO, SUSIE MADELAINE (LMP)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:MADELAINE
Last Name:WARTO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 E 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3712
Mailing Address - Country:US
Mailing Address - Phone:509-570-2663
Mailing Address - Fax:
Practice Address - Street 1:3711 E 31ST AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-3712
Practice Address - Country:US
Practice Address - Phone:509-570-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist