Provider Demographics
NPI:1134438831
Name:SURONEN, MARTHA ANN (IBCLC, RLC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:SURONEN
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15312 NE 90TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3597
Mailing Address - Country:US
Mailing Address - Phone:360-721-0252
Mailing Address - Fax:
Practice Address - Street 1:15312 NE 90TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-3597
Practice Address - Country:US
Practice Address - Phone:360-721-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula