Provider Demographics
NPI:1760559884
Name:PEEPLES, SUSAN M (FNP, CNM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:PEEPLES
Suffix:
Gender:F
Credentials:FNP, CNM
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 605
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OR
Mailing Address - Zip Code:97883-0605
Mailing Address - Country:US
Mailing Address - Phone:541-562-6062
Mailing Address - Fax:541-562-5757
Practice Address - Street 1:142 EAST DEARBORN
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:OR
Practice Address - Zip Code:97883-0605
Practice Address - Country:US
Practice Address - Phone:541-562-6062
Practice Address - Fax:541-562-5757
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR093006642N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR035423Medicaid
OR035423Medicaid