Provider Demographics
NPI:1700939733
Name:SCHILTZ, SUZANNE ROACHE (RN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ROACHE
Last Name:SCHILTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:ROACHE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11611 NW 10TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685
Mailing Address - Country:US
Mailing Address - Phone:360-608-3246
Mailing Address - Fax:
Practice Address - Street 1:11611 NW 10TH CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685
Practice Address - Country:US
Practice Address - Phone:360-608-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090003001RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000317Medicaid
OR015402000OtherBLUE CROSS