Individual
SUSAN M GORANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
9205 SW BARNES RD, 7W, PORTLAND, OR 97225-6603
(503) 216-4961
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
200450031NP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
200450031NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273935
—
OR
05
—
500627015
—
OR
01
—
P00461860
RR MEDICARE
OR
Enumeration date
06/21/2006
Last updated
03/10/2021
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