Individual
SUSAN HART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
62168 OB RILEY RD E2-16, BEND, OR 97701
(541) 389-8714
Mailing address
62168 OB RILEY RD E2-16, BEND, OR 97701
(541) 389-8714
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
000029202N1
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
000029202N6
OR
364SP0200X
Pediatric Clinical Nurse Specialist
000029202N2
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000029202N6
OREGON LICENSE
OR
Enumeration date
06/09/2010
Last updated
11/16/2016
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