PROMPORN JUNE SUWANABOL (NPI# 1710395058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710395058 |
| Entity Type | Individual |
| Full Name | PROMPORN JUNE SUWANABOL |
| Practice Address |
123 Hospital Dr Suite 2009 Watertown WI 53098-3331 |
| Practice Telephone | 9202629833 |
| Mailing Telephone | 9202629833 |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2014-12-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
3398-23 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
123 HOSPITAL DR SUITE 2009 |
| City | WATERTOWN |
| State | WI |
| Zip Code | 53098-3331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053314070 | George Andrew Boush | Ophthalmology | 123 Hospital Dr, Suite 1002, Watertown, WI 53098-3331 | 2005-05-23 |
| 1144600511 | Jillian Stevens | Hearing Instrument Specialist | 123 Hospital Dr, Ste 112, Watertown, WI 53098-3331 | 2015-06-01 |
| 1487053005 | Casey Jo Brown | Nurse Practitioner | 123 Hospital Dr, Suite 2009, Watertown, WI 53098-3331 | 2014-08-19 |
| 1912319575 | Connect Hearing, Inc. | Audiologist | 123 Hospital Dr, Ste 112, Watertown, WI 53098-3331 | 2014-05-29 |
| 1194072660 | Watertown Regional Medical Center, Inc | Otolaryngology | 123 Hospital Dr, Ste 2002, Watertown, WI 53098-3320 | 2012-08-14 |
| 1043586068 | Hearing Center, Inc. | Audiologist | 123 Hospital Dr, Ste 112, Watertown, WI 53098-3320 | 2012-03-23 |
| 1356627699 | Watertown Regional Medical Center, Inc | Family Medicine | 123 Hospital Dr, Ste 2004, Watertown, WI 53098-3331 | 2011-11-01 |
| 1043593916 | Watertown Regional Medical Center, Inc | Plastic Surgery | 123 Hospital Dr, Ste 2003, Watertown, WI 53098-3331 | 2011-09-27 |
| 1013296391 | Watertown Regional Medical Center, Inc | Physician Assistant | 123 Hospital Dr, Ste 2004, Watertown, WI 53098-3336 | 2011-08-04 |
| 1982982351 | Gordon Roy Marsden | Physician Assistant | 123 Hospital Dr, Suite 2006, Watertown, WI 53098-3331 | 2011-08-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528558749 | Watertown Physician Practices LLC | Eyewear Supplier (Equipment, not the service) | 123 Hospital Dr Ste 2005, Watertown, WI 53098 | 2018-05-14 |
| 1851822076 | Fort Health Care Inc | Otolaryngology | 123 Hospital Dr Suite 106a, Watertown, WI 53098 | 2017-03-21 |
| 1598045692 | Bonnie Kay Peot | Licensed Practical Nurse | 1420 Wedgewood Drive, Watertown, WI 53098 | 2011-08-19 |
| 1275790404 | Kathy R. Adkins | Physical Therapy Assistant | 1020 Hill Street, Watertown, WI 53098 | 2008-05-16 |
| 1336361294 | Patrice Walter | Occupational Therapist | 125 Hospital Dr., Watertown, WI 53098 | 2007-05-02 |
| 1720161284 | Carolyn T Schneider-donley | Optometrist | 622 N. Church Street, Watertown, WI 53098 | 2006-10-20 |
| 1730156431 | Mohamed H Yafai | Internal Medicine | 123 Hospital Drive, Suite 2009, Watertown, WI 53098 | 2006-03-02 |
| 1093711236 | Dana M. Fields | Physician Assistant | 134 Hospital Drive, Watertown, WI 53098 | 2005-06-22 |
| 1528560018 | Watertown Medical Center LLC | Psychiatric Unit | 125 Hospital Drive, Watertown, WI 53098 | 2018-03-01 |
| 1437544863 | Zachary Richardson | Internal Medicine | 125 Hospital Dr, Watertown, WI 53098 | 2015-04-02 |
| Find all providers in zip 53098 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417288325 | Kathryn E Doremus | Physician Assistant | 1571 Washington St Ste 201, Watertown, NY 13601 | 2010-01-18 |
| 1275529554 | Melissa A Charlebois | Physician Assistant | 826 Washington St, Suite 204, Watertown, NY 13601-4063 | 2005-09-22 |
| 1154327161 | Milagros C Smith | Physician Assistant | 727 Washington St, Watertown, NY 13601-4031 | 2005-06-23 |
| 1811509276 | Lisa Dwello | Physician Assistant | 160 Stone St, Watertown, NY 13601-3261 | 2020-08-18 |
| 1205469186 | Robert James Pickeral Jr. | Physician Assistant | 53-59 Public Sq Ste 301, Watertown, NY 13601-2674 | 2020-02-19 |
| 1730644949 | Sarabrooke Mowery | Physician Assistant | 830 Washington St, Watertown, NY 13601-4034 | 2019-02-01 |
| 1881018588 | Katherine S. Johnson | Physician Assistant | 1571 Washington St, Suite 104, Watertown, NY 13601-9304 | 2014-02-15 |
| 1356673883 | Justin James Martinson | Physician Assistant | 401 9th Ave Nw, Watertown, SD 57201-1548 | 2010-02-09 |
| 1063691491 | Maria Noelle Alicea | Physician Assistant | 1575 Washington St, Watertown, NY 13601-9371 | 2007-11-01 |
| 1467534396 | Thomas U. Moody Sr. | Physician Assistant | 21017 State Route 12f, Watertown, NY 13601-1078 | 2006-10-19 |
| Find all providers in WATERTOWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.