Provider Demographics
NPI:1487712188
Name:BONE O'BRIEN, SUSAN F (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:BONE O'BRIEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:615 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2439
Mailing Address - Country:US
Mailing Address - Phone:360-385-9400
Mailing Address - Fax:360-385-9401
Practice Address - Street 1:615 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2439
Practice Address - Country:US
Practice Address - Phone:360-385-9400
Practice Address - Fax:360-385-9401
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00093889363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7311707Medicaid
WA50D0882476OtherCLIA
WA50D0882476OtherCLIA
WAA07991Medicare UPIN
WABJ5055721OtherDEA