Individual
SUSAN AMIDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDE
Contact information
Practice address
555 BLACK OAK DR STE 310, MEDFORD, OR 97504-8491
(541) 789-4658
Mailing address
2620 E BARNETT RD STE H, MEDFORD, OR 97504-8383
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
091000133
OR
163WD0400X
Diabetes Educator Registered Nurse
20610437
OR
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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