Provider Demographics
NPI:1720787203
Name:COLEMER, SUSAN MERIE (A-GNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MERIE
Last Name:COLEMER
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MERIE
Other - Last Name:OAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2976 CHAPEL VALLEY RD APT 101
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7417
Mailing Address - Country:US
Mailing Address - Phone:608-445-3767
Mailing Address - Fax:
Practice Address - Street 1:16463 BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4259
Practice Address - Country:US
Practice Address - Phone:541-748-9634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI234974163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI234974OtherREGISTERED NURSE