Provider Demographics
NPI:1265663058
Name:GAGE, SUZANN ADRIENNE (APNP, WHNP-BC, LAC)
Entity Type:Individual
Prefix:
First Name:SUZANN
Middle Name:ADRIENNE
Last Name:GAGE
Suffix:
Gender:F
Credentials:APNP, WHNP-BC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 CURRY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8508
Mailing Address - Country:US
Mailing Address - Phone:619-260-0810
Mailing Address - Fax:541-802-0787
Practice Address - Street 1:909 CURRY RD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8508
Practice Address - Country:US
Practice Address - Phone:619-260-0810
Practice Address - Fax:541-802-0787
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202102860NP-PP363LX0001X
OR181645171100000X
CARN456541NP5830363LX0001X
CAAC5147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No171100000XOther Service ProvidersAcupuncturist