Individual
SUE FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
426 SW STARK ST, 8TH FLOOR, PORTLAND, OR 97204-2347
(503) 988-3674
(503) 988-5484
Mailing address
619 NW 6TH AVE, FL 5, PORTLAND, OR 97209-3964
(503) 988-7468
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
000032127N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22959
—
OR
Enumeration date
01/19/2007
Last updated
01/08/2020
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