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Individual

SUSAN MICHELLE MIXON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3285 FERGUSON ST SW, TUMWATER, WA 98512
(360) 280-9889
Mailing address
3285 FERGUSON ST SW, TUMWATER, WA 98512-6143
(360) 943-1907

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP00045866
WA

Other

Enumeration date
12/10/2020
Last updated
03/06/2023
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