Individual
SUZANNE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
19500 SE STARK ST, PORTLAND, OR 97233-5757
(800) 813-2000
Mailing address
PO BOX 1117, RIDGEFIELD, WA 98642-1117
(360) 771-6222
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201242664RN
OR
Other
Enumeration date
08/15/2025
Last updated
08/15/2025
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