Provider Demographics
NPI:1174652473
Name:JAGGER, SUZANNE MICHELE (CRNA)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MICHELE
Last Name:JAGGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 NW 126TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4627
Mailing Address - Country:US
Mailing Address - Phone:408-364-6103
Mailing Address - Fax:
Practice Address - Street 1:12525 NW CORNELL RD STE 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5615
Practice Address - Country:US
Practice Address - Phone:971-232-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626041367500000X
OR201602463CRNA-PP367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered