Provider Demographics
NPI:1457386732
Name:TREZONA, SUSAN (CNM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TREZONA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:QUIGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 70368
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0120
Mailing Address - Country:US
Mailing Address - Phone:541-485-2777
Mailing Address - Fax:541-246-2353
Practice Address - Street 1:3100 MARTIN LUTHER KING JR PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7514
Practice Address - Country:US
Practice Address - Phone:541-485-2777
Practice Address - Fax:541-246-2353
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000031314N5163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR085282Medicaid
OR085282Medicaid
ORR0000WCJKCMedicare PIN
OR121203Medicare PIN