Provider Demographics
NPI:1760685739
Name:KAVET, SUZANNE (MSN, PNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:KAVET
Suffix:
Gender:F
Credentials:MSN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SW BOND AVE
Mailing Address - Street 2:UNIT 312
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4571
Mailing Address - Country:US
Mailing Address - Phone:617-775-3996
Mailing Address - Fax:
Practice Address - Street 1:253 SUMMER ST
Practice Address - Street 2:5TH FLR-CMA
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-1114
Practice Address - Country:US
Practice Address - Phone:888-897-8947
Practice Address - Fax:617-772-5519
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA176797363LC1500X
OR201407057NP-PP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health