Provider Demographics
NPI:1548457039
Name:JONES, SUSAN J (ARNP)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:J
Last Name:JONES
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 1:1001 N BROADWAY
Mailing Address - Street 2:SUITE A3
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1586
Mailing Address - Country:US
Mailing Address - Phone:425-317-0300
Mailing Address - Fax:
Practice Address - Street 1:1001 N BROADWAY
Practice Address - Street 2:SUITE A3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1586
Practice Address - Country:US
Practice Address - Phone:425-317-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30007783OtherWSL
WAG8878219Medicare PIN
WAAP30007783OtherWSL