Healthcare Provider Details

I. General information

NPI: 1407033327
Provider Name (Legal Business Name): KRISTY SUZANNE ESCUDIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10699 SE HAPPY VALLEY DR
PORTLAND OR
97086-6079
US

IV. Provider business mailing address

10699 SE HAPPY VALLEY DR
PORTLAND OR
97086-6079
US

V. Phone/Fax

Practice location:
  • Phone: 503-761-2300
  • Fax:
Mailing address:
  • Phone: 503-761-2300
  • 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: