Healthcare Provider Details

I. General information

NPI: 1609785658
Provider Name (Legal Business Name): SUSANA CORTEZ GONZALEZ MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZIE CORTEZ MSN, APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BROOKLAKE RD NE
KEIZER OR
97303-9413
US

IV. Provider business mailing address

2000 BROOKLAKE RD NE
KEIZER OR
97303-9413
US

V. Phone/Fax

Practice location:
  • Phone: 971-218-0865
  • Fax:
Mailing address:
  • Phone: 971-218-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10066680
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: