Provider Demographics
NPI:1336251818
Name:JAMIEL, SUSAN E (PMHNP/ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:JAMIEL
Suffix:
Gender:F
Credentials:PMHNP/ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 NE 41ST ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6791
Mailing Address - Country:US
Mailing Address - Phone:360-253-6425
Mailing Address - Fax:
Practice Address - Street 1:7600 NE 41ST ST
Practice Address - Street 2:SUITE 310
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6791
Practice Address - Country:US
Practice Address - Phone:360-253-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09900743N6363LP0808X
WAAP30005482363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130177Medicare ID - Type Unspecified
ORQ21530Medicare UPIN