Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP30003162 | WA |
N | 363LW0102X | Nurse Practitioner - Women's Health | AP30003162 | WA |
NPI | 1073540316 |
---|---|
Provider Name | Susan E. Dippery |
First Address | Seattle, WA 98104-2420 |
Second Address | Seattle, WA 98104-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34461U | REGENCE BLUE SHIELD PIN (01) | WA |
8929520 | L&I CRIME VICTIMS (01) | WA |