Individual
SUSAN MARIE GILLISPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3838 PACIFIC AVE, FOREST GROVE, OR 97116-2224
(503) 992-0288
Mailing address
7272 THEODORE DAWES RD STE B, THEODORE, AL 36582-4136
(251) 607-6653
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201240084RN
OR
363LP2300X
Primary Care Nurse Practitioner
Primary
201501505NP-PP
OR
Other
Enumeration date
03/17/2015
Last updated
04/26/2021
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