Provider Demographics
NPI:1598717282
Name:FEE, SUSAN TROY (ANP GNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:TROY
Last Name:FEE
Suffix:
Gender:F
Credentials:ANP GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20668 SW 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9101
Mailing Address - Country:US
Mailing Address - Phone:503-885-7744
Mailing Address - Fax:
Practice Address - Street 1:1185 S ELM ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3935
Practice Address - Country:US
Practice Address - Phone:503-723-4670
Practice Address - Fax:503-266-6649
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP67181Medicare UPIN