Provider Demographics
NPI:1427245109
Name:SUSAN G. TAYLOR, CRNA CORP
Entity type:Organization
Organization Name:SUSAN G. TAYLOR, CRNA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:360-653-3588
Mailing Address - Street 1:PO BOX 2329
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-7329
Mailing Address - Country:US
Mailing Address - Phone:360-336-6517
Mailing Address - Fax:
Practice Address - Street 1:7525 69TH AVE NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7788
Practice Address - Country:US
Practice Address - Phone:360-653-3588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005906367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0226583OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA1687TAOtherREGENCE BLUE SHIELD
WA9654377Medicaid
WA1675TAOtherREGENCE BLUE SHIELD
WA1678TAOtherREGENCE BLUE SHIELD
WA1699TAOtherREGENCE BLUE SHIELD
WA0226583OtherDEPARTMENT OF LABOR AND INDUSTRIES