Provider Demographics
NPI:1730686569
Name:BOWERS, SUSAN M (CPE)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:BOWERS
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:PROF
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ELECTROLOGIST
Mailing Address - Street 1:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-0741
Mailing Address - Country:US
Mailing Address - Phone:425-999-5758
Mailing Address - Fax:
Practice Address - Street 1:365 118TH AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-9805
Practice Address - Country:US
Practice Address - Phone:425-999-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty