Healthcare Provider Details

I. General information

NPI: 1780662213
Provider Name (Legal Business Name): SUZANNE A. SCOPES N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 NE 28TH AVE
PORTLAND OR
97232-3150
US

IV. Provider business mailing address

517 NE MONROE ST
PORTLAND OR
97212-3155
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-0812
  • Fax: 503-233-9151
Mailing address:
  • Phone: 503-230-0812
  • Fax: 503-233-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberOR642
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: