MEDICARE: SUSAN A KASS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	092000175N1	OR

General Provider Information

NPI Number	:	1811936362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A KASS FNP

Provider Business Mailing Address
First Line	:	619 NW 6TH AVE FL 5
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-3964
Country	:	US
Telephone Number	:	503-988-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	6736 NE KILLINGSWORTH ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97218-3338
Country	:	US
Telephone Number	:	509-988-3991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	04/21/2023

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