Provider Demographics
NPI:1942583372
Name:DULA, SUZAN LYNN (PSYD, PA-C)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:LYNN
Last Name:DULA
Suffix:
Gender:F
Credentials:PSYD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W RIVERSIDE AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1099
Mailing Address - Country:US
Mailing Address - Phone:509-747-0165
Mailing Address - Fax:
Practice Address - Street 1:2204 PACIFIC AVE N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-3300
Practice Address - Country:US
Practice Address - Phone:360-642-3787
Practice Address - Fax:360-642-2096
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002915363AM0700X
WAPY60420557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical