Provider Demographics
NPI:1164492666
Name:ROGERS, SUSAN GAYLE (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAYLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:597 POINT BROWN AVE NE
Practice Address - Street 2:
Practice Address - City:OCEAN SHORES
Practice Address - State:WA
Practice Address - Zip Code:98569
Practice Address - Country:US
Practice Address - Phone:604-911-3993
Practice Address - Fax:360-289-9982
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00129267163WG0000X, 163WR0006X
WAAP30006312363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9642661Medicaid
WA0173362OtherL&I
WA614161500OtherDOL OWCP FECA
WA9642661Medicaid
WAGAB36314Medicare PIN