Individual
SUSAN BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
218 N PINE STREET, HALFWAY, OR 97834
(541) 742-5023
(541) 742-7210
Mailing address
PO BOX 3397, PORTLAND, OR 97208-3397
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200550175NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243015
—
OR
Enumeration date
07/27/2006
Last updated
08/30/2018
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