Individual
SUZETTE WIDDISON IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPH PAC
Contact information
Practice address
4700 POINT FOSDICK DR STE 220, GIG HARBOR, WA 98335-1706
(253) 851-5121
(253) 851-3059
Mailing address
4700 POINT FOSDICK DR STE 220, GIG HARBOR, WA 98335-1706
(253) 851-5121
(253) 851-3059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004945
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0239348
STATE L&I
WA
01
—
0291728
L&I
WA
05
—
8500191
—
WA
01
—
G8907654
MEDICARE
WA
Enumeration date
12/02/2005
Last updated
05/19/2021
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