Provider Demographics
NPI:1942302286
Name:GNAEGY, SUZANNE CONRAD (DO)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:CONRAD
Last Name:GNAEGY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NESPELEM/SANPOIL STREET
Mailing Address - Street 2:PO BOX 71
Mailing Address - City:NESPELEM
Mailing Address - State:WA
Mailing Address - Zip Code:99155-0071
Mailing Address - Country:US
Mailing Address - Phone:509-634-2900
Mailing Address - Fax:509-634-2990
Practice Address - Street 1:29 NESPELEM/SANPOIL STREET
Practice Address - Street 2:
Practice Address - City:NESPELEM
Practice Address - State:WA
Practice Address - Zip Code:99155-0071
Practice Address - Country:US
Practice Address - Phone:509-634-2900
Practice Address - Fax:509-634-2990
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7100100Medicaid