Active NPI
Revallee Ann Suffern-Osburn, L.M.P.
- Specialist
- Stanwood, WA
National Provider Identifier
1316007529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA00019630
- Practice address
- 9522 271St Street NW
Stanwood, WA 98292 - Phone
- (360) 629-0800
- Fax
- (360) 629-6042
- NPI assigned
- Dec 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA00019630 | WA | Primary |
Addresses
Primary practice location
9522 271St Street NW
Stanwood, WA 98292
Mailing address
632 Laura Drive
Camano Island, WA 98282
Phone (360) 387-7390
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0187950 | Other | WA | LABOR & INDUSTRIES |
| 163474 | Other | WA | AMTA MEMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Theology
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00019630 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316007529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "632 LAURA DRIVE",
"city": "CAMANO ISLAND",
"state": "WA",
"postal_code": "98282",
"telephone_number": "360-387-7390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9522 271ST STREET NW",
"city": "STANWOOD",
"state": "WA",
"postal_code": "98292",
"telephone_number": "360-629-0800",
"fax_number": "360-629-6042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUFFERN-OSBURN",
"first_name": "REVALLEE",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "L.M.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA00019630",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "0187950",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMTA MEMBER",
"identifier": "163474",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stanwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.