Provider Demographics
NPI:1174544761
Name:WILLIS, SUSAN G (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:WILLIS
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6614
Practice Address - Country:US
Practice Address - Phone:360-671-3345
Practice Address - Fax:360-650-1354
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-07-24
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Provider Licenses
StateLicense IDTaxonomies
WAAP30000325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA423898016OtherGROUP HEALTH COOPERATIVE
WA9602970Medicaid
WA8925053OtherL & I (CRIME VICTIM)
WA192942512OtherUS DEPT OF LABOR
WA0128742OtherL & I (REGULAR)
WA25892OtherREGENCE BLUESHIELD
WA0500013378OtherRAILROAD MEDICARE
WA9602970Medicaid
WA192942512OtherUS DEPT OF LABOR