Individual
SUSANNA NILA BASAPPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
MD.MD.70104522
WA
390200000X
Student in an Organized Health Care Education/Training Program
RS2023-1193
NM
Other
Enumeration date
03/28/2023
Last updated
05/29/2026
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