Provider Demographics
NPI:1578562401
Name:TERRAN, SUSAN I (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:I
Last Name:TERRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1850
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-1850
Mailing Address - Country:US
Mailing Address - Phone:541-592-4111
Mailing Address - Fax:541-592-3916
Practice Address - Street 1:319 CAVES HWY
Practice Address - Street 2:
Practice Address - City:CAVE JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:97523-9604
Practice Address - Country:US
Practice Address - Phone:541-592-4111
Practice Address - Fax:541-592-3916
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00515363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR127725Medicaid
OR127725Medicaid
ORP03004Medicare UPIN