Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | AP61159008 | WA |
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP61159008 | WA |
NPI | 1063081289 |
---|---|
Provider Name | Susanne Noel Henderson |
First Address | Tacoma, WA 98405-5305 |
Second Address | Tacoma, WA 98405-5305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
217925 | (05) | WA |