Provider Demographics
NPI:1871647313
Name:SHLIFER, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:SHLIFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19735 10TH AVENUE NE
Mailing Address - Street 2:SUITE S-102
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:360-779-5461
Mailing Address - Fax:360-779-6182
Practice Address - Street 1:19735 10TH AVENUE NE
Practice Address - Street 2:SUITE S-102
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-779-5461
Practice Address - Fax:360-779-6182
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00035541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB01574Medicare ID - Type Unspecified
B09806Medicare UPIN