Provider Demographics
NPI:1447234901
Name:HOFFMAN, SUSAN ELAINE (PMHNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 SW DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-9211
Mailing Address - Country:US
Mailing Address - Phone:503-245-9277
Mailing Address - Fax:503-245-0518
Practice Address - Street 1:5520 SW MACADAM AVE
Practice Address - Street 2:HARBOR SQUARE SW, SUITE 260
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3741
Practice Address - Country:US
Practice Address - Phone:503-799-9519
Practice Address - Fax:503-245-0518
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250048NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health