Provider Demographics
NPI:1205362597
Name:EMERY, SUZANNE CAROL (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:CAROL
Last Name:EMERY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11790 SW BARNES RD STE 140
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5938
Mailing Address - Country:US
Mailing Address - Phone:503-643-2100
Mailing Address - Fax:503-643-7300
Practice Address - Street 1:11790 SW BARNES RD STE 140
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5938
Practice Address - Country:US
Practice Address - Phone:503-643-2100
Practice Address - Fax:503-643-7300
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201608996NP-PP363LF0000X
OR201808996NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily