Provider Demographics
NPI:1265081822
Name:HORTON, SUE K
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:K
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MAY CREEK RD # B
Mailing Address - Street 2:
Mailing Address - City:GOLD BAR
Mailing Address - State:WA
Mailing Address - Zip Code:98251-9433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 MAY CREEK RD # B
Practice Address - Street 2:
Practice Address - City:GOLD BAR
Practice Address - State:WA
Practice Address - Zip Code:98251-9433
Practice Address - Country:US
Practice Address - Phone:425-238-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
3747A0650XOtherTECHNICIAN-ATTENDANT CARE PROVIDER