Provider Demographics
NPI:1568761757
Name:BRICK, SUSAN DIANNA DEBUSE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANNA DEBUSE
Last Name:BRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82542 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9408
Mailing Address - Country:US
Mailing Address - Phone:541-895-2281
Mailing Address - Fax:
Practice Address - Street 1:82542 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9408
Practice Address - Country:US
Practice Address - Phone:541-895-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201041852RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse