Provider Demographics
NPI:1194746768
Name:VINEBERG, SUSAN M (RNFA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:VINEBERG
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 43RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2306
Mailing Address - Country:US
Mailing Address - Phone:206-999-8428
Mailing Address - Fax:
Practice Address - Street 1:5028 43RD AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2306
Practice Address - Country:US
Practice Address - Phone:206-999-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00101365163W00000X, 364SP2800X
WARN00101365163WM0705X, 364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00101365OtherNURSING LISENCE
WA0209485OtherLABOR & INDUSTRIES