Provider Demographics
NPI:1396740189
Name:NETHERTON, SUSAN H (APRN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:H
Last Name:NETHERTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20632 76TH AVE W
Mailing Address - Street 2:APT 12
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6813
Mailing Address - Country:US
Mailing Address - Phone:425-697-4305
Mailing Address - Fax:
Practice Address - Street 1:20632 76TH AVE W
Practice Address - Street 2:APT 12
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-6813
Practice Address - Country:US
Practice Address - Phone:425-697-4305
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002433163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult