Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN00093889 | WA |
NPI | 1487712188 |
---|---|
Provider Name | Susan F Bone O'brien |
First Address | Port Townsend, WA 98368-2439 |
Second Address | Port Townsend, WA 98368-2439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50D0882476 | CLIA (01) | WA |
7311707 | (05) | WA |
A07991 | (02) | WA |
BJ5055721 | DEA (01) | WA |