Healthcare Provider Details

I. General information

NPI: 1629183231
Provider Name (Legal Business Name): MRS. SUSAN KIM SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN KIM SCOTT MASTERS IN SIENCE

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

22333 S GRAPEVINE RD
WEST LINN OR
97068-9211
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-2657
  • Fax:
Mailing address:
  • Phone: 503-697-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: