Individual
MS. SUZANNE KENT NIEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
66 CLUB RD STE 160, EUGENE, OR 97401-2439
(541) 345-1722
(541) 485-7049
Mailing address
PO BOX 70779, SPRINGFIELD, OR 97475-0137
(541) 345-1722
(541) 485-7049
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
202004904RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202004996NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14101489
CAQH ID
—
05
—
500798419
—
OR
Enumeration date
05/04/2007
Last updated
09/28/2023
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