Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OP60698789 | WA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 101139 | MO |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 101139 | MO |
NPI | 1700864287 |
---|---|
Provider Name | Dr. Susan E Pearson |
First Address | Portland, OR 97208-3360 |
Second Address | Everett, WA 98201-1665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G19945 | (02) |