Provider Demographics
NPI:1427128578
Name:GINS, SUSAN LYNN (CN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNN
Last Name:GINS
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 NE BOTHELL WAY
Mailing Address - Street 2:C392
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028
Mailing Address - Country:US
Mailing Address - Phone:206-794-8892
Mailing Address - Fax:425-483-6334
Practice Address - Street 1:2915 E. MADISON STREET
Practice Address - Street 2:#208
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112
Practice Address - Country:US
Practice Address - Phone:206-795-8892
Practice Address - Fax:425-483-6334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU00001017133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601856576OtherBUSINESS LICENSE
WANU00001017OtherSTATE LICENCE