Provider Demographics
NPI:1770574303
Name:CHANDLER, SUZAN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 SE TV HWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-8252
Mailing Address - Country:US
Mailing Address - Phone:503-681-4223
Mailing Address - Fax:503-591-9411
Practice Address - Street 1:7545 SE TV HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-8252
Practice Address - Country:US
Practice Address - Phone:503-681-4223
Practice Address - Fax:503-591-9411
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450111NP363L00000X
MNR 1108969 9363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126370Medicaid
ORQ48093Medicare UPIN
OR131976Medicare ID - Type Unspecified