Provider Demographics
NPI:1407033327
Name:ESCUDIE, KRISTY SUZANNE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:SUZANNE
Last Name:ESCUDIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10699 SE HAPPY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6079
Mailing Address - Country:US
Mailing Address - Phone:503-761-2300
Mailing Address - Fax:
Practice Address - Street 1:10699 SE HAPPY VALLEY DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086-6079
Practice Address - Country:US
Practice Address - Phone:503-761-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse