Provider Demographics
NPI:1902021868
Name:WEST, SUSAN L (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SW BUTTERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1710
Mailing Address - Country:US
Mailing Address - Phone:503-914-7439
Mailing Address - Fax:
Practice Address - Street 1:808 SW ALDER ST
Practice Address - Street 2:STE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3133
Practice Address - Country:US
Practice Address - Phone:503-226-2203
Practice Address - Fax:503-223-4231
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse