Individual
SUSAN E DETWEILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
MD00014967
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0247886
LABOR & INDUSTRY
WA
01
—
220024123
RAILROAD MEDICARE
—
05
—
8270605
—
WA
01
—
MD967WA
ALASKA MEDICAID
WA
01
—
PA6985
BLUE SHIELD
WA
01
—
US0861500
AETNA/USHC SPECIALIST
WA
Enumeration date
07/18/2006
Last updated
07/22/2009
Update your record
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