Provider Demographics
NPI:1326724600
Name:DUNCAN, SUSANNE LYNN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:LYNN
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 SOUTH 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4746
Mailing Address - Country:US
Mailing Address - Phone:541-882-1487
Mailing Address - Fax:541-851-3983
Practice Address - Street 1:330 CHILOQUIN BLVD
Practice Address - Street 2:
Practice Address - City:CHILOQUIN
Practice Address - State:OR
Practice Address - Zip Code:97624
Practice Address - Country:US
Practice Address - Phone:208-501-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDF06230879207Q00000X
OR10002010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine