Individual
SUSAN E RIVARD-DIBENEDETTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
2850 SE POWELL VALLEY RD, GRESHAM, OR 97080-1494
(503) 666-5050
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA151129
OR
363AM0700X
Medical Physician Assistant
PA10003271
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8377012
—
WA
Enumeration date
03/29/2006
Last updated
02/10/2017
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