Provider Demographics
NPI:1417136938
Name:AHN, SUZANNE S (MS, FNP-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:S
Last Name:AHN
Suffix:
Gender:F
Credentials:MS, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 E BURNSIDE ST
Mailing Address - Street 2:BASEMENT
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2731
Mailing Address - Country:US
Mailing Address - Phone:503-988-4424
Mailing Address - Fax:503-988-4464
Practice Address - Street 1:2735 NE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5304
Practice Address - Country:US
Practice Address - Phone:503-988-3382
Practice Address - Fax:503-988-3167
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550135NP363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213688Medicaid
OR213688Medicaid