Individual
LAUREN MARIE SUSORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
724 S CENTRAL AVE STE 101, MEDFORD, OR 97501-7808
(541) 249-7724
Mailing address
414 JAMES CIR, TALENT, OR 97540-9760
(541) 324-0812
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10061429
OR
Other
Enumeration date
05/26/2026
Last updated
05/28/2026
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