Individual
MRS. REVALLEE ANN SUFFERN-OSBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
9522 271ST STREET NW, STANWOOD, WA 98292
(360) 629-0800
(360) 629-6042
Mailing address
632 LAURA DRIVE, CAMANO ISLAND, WA 98282
(360) 387-7390
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00019630
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0187950
LABOR & INDUSTRIES
WA
01
—
163474
AMTA MEMBER
WA
Enumeration date
12/11/2006
Last updated
07/08/2007
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