Provider Demographics
NPI:1730268392
Name:JOUFLAS, SUSAN J (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:JOUFLAS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:1624 SOUTH I STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5093
Mailing Address - Country:US
Mailing Address - Phone:253-428-8700
Mailing Address - Fax:253-383-3376
Practice Address - Street 1:2920 SOUTH MERIDIAN
Practice Address - Street 2:SUITE 100
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1428
Practice Address - Country:US
Practice Address - Phone:253-841-4296
Practice Address - Fax:253-841-2435
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2012-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10003336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8321580Medicaid
WA8933735OtherSTATE CRIME VICTIMS
WA0129371OtherSTATE L&I
WA8933735OtherSTATE CRIME VICTIMS
WA0129371OtherSTATE L&I