Provider Demographics
NPI:1376617175
Name:DUFFY, SUSAN CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 116TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3043
Mailing Address - Country:US
Mailing Address - Phone:425-455-2275
Mailing Address - Fax:425-455-1511
Practice Address - Street 1:1810 116TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3043
Practice Address - Country:US
Practice Address - Phone:425-455-2275
Practice Address - Fax:425-455-1511
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8868334Medicare PIN
WAU11464Medicare UPIN