Provider Demographics
NPI:1477740389
Name:PAUL, SUSAN K (LMT, LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:PAUL
Suffix:
Gender:F
Credentials:LMT, LMP
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, LMP
Mailing Address - Street 1:2191 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9108
Mailing Address - Country:US
Mailing Address - Phone:503-434-2824
Mailing Address - Fax:
Practice Address - Street 1:2191 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9108
Practice Address - Country:US
Practice Address - Phone:503-434-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist