Individual
SUSAN M SANBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3021 GRIFFIN AVE, ENUMCLAW, WA 98022-2369
(360) 825-6511
(360) 825-6536
Mailing address
3021 GRIFFIN AVE, ENUMCLAW, WA 98022-2369
(360) 825-6511
(360) 825-6536
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10002391
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131056
STATE L&I
WA
05
—
8370843
—
WA
01
—
8929994
STATE CRIME VICTIMS
WA
01
—
97008681
MEDICARE RAILROAD
WA
Enumeration date
07/31/2006
Last updated
11/17/2010
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