Healthcare Provider Details

I. General information

NPI: 1235544099
Provider Name (Legal Business Name): SUSAN ERIKA HAPP RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 NE 25TH AVE
PORTLAND OR
97211-6107
US

IV. Provider business mailing address

5715 NE 25TH AVE
PORTLAND OR
97211-6107
US

V. Phone/Fax

Practice location:
  • Phone: 503-358-2874
  • Fax:
Mailing address:
  • Phone: 503-358-2874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number096000345RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: