Provider Demographics
NPI:1578207635
Name:SANSAVATH, SUTTINEE HANNAH (ND)
Entity type:Individual
Prefix:DR
First Name:SUTTINEE
Middle Name:HANNAH
Last Name:SANSAVATH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 TACOMA AVE S APT 506
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-2023
Mailing Address - Country:US
Mailing Address - Phone:903-227-9773
Mailing Address - Fax:
Practice Address - Street 1:1944 PACIFIC AVE STE 301A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3121
Practice Address - Country:US
Practice Address - Phone:360-447-8486
Practice Address - Fax:206-339-1628
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175F00000X
WANT61347053175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty