Individual
SUZANNE GWEN WATNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3442
Mailing address
3710 SW US VETERANS HOSPITAL RD, P3NEPH, PORTLAND, OR 97239-2964
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD23936
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286360
—
OR
Enumeration date
07/31/2006
Last updated
07/10/2007
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