Provider Demographics
NPI:1396947065
Name:EKI, SUSAN RUTH (PMHNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RUTH
Last Name:EKI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:RUTH
Other - Last Name:SAGAWA-EKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:644 SW WALTERS DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9351
Mailing Address - Country:US
Mailing Address - Phone:971-888-2014
Mailing Address - Fax:971-206-6387
Practice Address - Street 1:1217 NE BURNSIDE RD STE 503C
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5770
Practice Address - Country:US
Practice Address - Phone:971-888-2014
Practice Address - Fax:971-206-6387
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR077037817N2363LP0200X, 363LP0808X
OR200250006NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR077037817N2-PNP-PPOtherNURSEPRACTITIONER LICENSE