Provider Demographics
NPI:1528326451
Name:STOLZENBACH, SUSAN KATHRYN (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KATHRYN
Last Name:STOLZENBACH
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 1:1460 N 16TH AVE
Mailing Address - Street 2:STE G
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7102
Mailing Address - Country:US
Mailing Address - Phone:509-575-7760
Mailing Address - Fax:509-575-7796
Practice Address - Street 1:1460 N 16TH AVE
Practice Address - Street 2:STE G
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7102
Practice Address - Country:US
Practice Address - Phone:509-575-7760
Practice Address - Fax:509-575-7796
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-28
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60259853363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health