Provider Demographics
NPI:1952722241
Name:SUSAN PUTAANSUU, MN, ARNP, PLLC
Entity type:Organization
Organization Name:SUSAN PUTAANSUU, MN, ARNP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUTAANSUU
Authorized Official - Suffix:
Authorized Official - Credentials:MN, ARNP, PMHNP-BC
Authorized Official - Phone:360-602-0355
Mailing Address - Street 1:406 SIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4541
Mailing Address - Country:US
Mailing Address - Phone:206-459-3808
Mailing Address - Fax:360-602-0356
Practice Address - Street 1:1950 POTTERY AVE
Practice Address - Street 2:SUITE 134
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2592
Practice Address - Country:US
Practice Address - Phone:360-602-0355
Practice Address - Fax:360-602-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60249845363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty