Individual
SUSAN T CHACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1675 W 11TH AVE, EUGENE, OR 97402-3711
(480) 719-0098
Mailing address
4771 CALUMET WAY, EUGENE, OR 97404-3306
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
263405
AZ
Other
Enumeration date
08/10/2023
Last updated
02/12/2025
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