Provider Demographics
NPI:1710077607
Name:DAVIES, SUSANNE M (ARNP, WHCNP)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:M
Last Name:DAVIES
Suffix:
Gender:F
Credentials:ARNP, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 SW BARNES RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6772
Mailing Address - Country:US
Mailing Address - Phone:503-734-3535
Mailing Address - Fax:503-734-3530
Practice Address - Street 1:9701 SW BARNES RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6772
Practice Address - Country:US
Practice Address - Phone:503-734-3535
Practice Address - Fax:503-734-3530
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003214363LW0102X
OR085080103N7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8857367Medicare ID - Type Unspecified
WAP32971Medicare UPIN