Provider Demographics
NPI:1245419399
Name:VOCKERT-BURKE, SUSAN MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:VOCKERT-BURKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 NE 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3647
Mailing Address - Country:US
Mailing Address - Phone:503-288-0083
Mailing Address - Fax:503-288-7843
Practice Address - Street 1:2647 NE 33RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3647
Practice Address - Country:US
Practice Address - Phone:503-288-0083
Practice Address - Fax:503-288-7843
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750097NP FNP-PP363LF0000X
OR200750097NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR139922Medicare PIN