Individual
SUSAN MARIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
426 SW STARK ST, 8TH FLOOR, PORTLAND, OR 97204-2347
(503) 988-3674
(503) 988-5180
Mailing address
421 SW OAK ST, 210, PORTLAND, OR 97204-1817
(503) 988-3674
(503) 988-4098
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
200250033NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
Enumeration date
03/01/2007
Last updated
12/21/2009
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