Provider Demographics
NPI:1336419803
Name:DALGARN, SUZANNE MARIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:DALGARN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17311 135TH AVE NE
Mailing Address - Street 2:BUILDING B SUITE 300
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-3519
Mailing Address - Country:US
Mailing Address - Phone:425-879-1719
Mailing Address - Fax:
Practice Address - Street 1:17311 135TH AVE NE
Practice Address - Street 2:BUILDING B SUITE 300
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9560
Practice Address - Country:US
Practice Address - Phone:425-879-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60246448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health