Healthcare Provider Details

I. General information

NPI: 1346742095
Provider Name (Legal Business Name): SUSAN NJOROGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 SW MASTERS LOOP APT 212
BEAVERTON OR
97078-1453
US

IV. Provider business mailing address

26424 GAITED HORSE TRL
SOUTH BEND IN
46619-4725
US

V. Phone/Fax

Practice location:
  • Phone: 971-507-2209
  • Fax: 971-507-2209
Mailing address:
  • Phone: 574-383-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10030310
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: