Individual
DR. SUSAN OLDENKAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12811 8TH AVE W, SUITE D-109, EVERETT, WA 98204-6335
(425) 743-7888
(425) 355-3055
Mailing address
12811 8TH AVE W, SUITE D-109, EVERETT, WA 98204-6335
(425) 743-7888
(425) 355-3055
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD00023394
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011832
—
WA
01
—
91-1504734
TAX ID
WA
Enumeration date
02/24/2007
Last updated
06/03/2010
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