Basic Information
| Provider Information | |||||||||
| NPI: | 1699257824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARVEL | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | SHILAND | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1231 116TH AVE NE STE 535 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256881916 | ||||||||
| FaxNumber: | 4256881901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1231 116TH AVE NE STE 535 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256881916 | ||||||||
| FaxNumber: | 4256881901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2018 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.