Basic Information
| Provider Information | |||||||||
| NPI: | 1235133067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILBACH | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 S UNION AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984051323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535032598 | ||||||||
| FaxNumber: | 2536822427 | ||||||||
| Practice Location | |||||||||
| Address1: | 34503 9TH AVE S | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538389839 | ||||||||
| FaxNumber: | 2536619077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP60089224 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 0024164185 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | G8885531 | 01 | WA | PTAN (N) | OTHER | G8885532 | 01 | WA | PTAN (S) | OTHER | 008933448 | 05 | VA | MEDICAID |