Healthcare Provider Details

I. General information

NPI: 1770679458
Provider Name (Legal Business Name): SUZANNE C. COOPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 N INTERSTATE AVE
PORTLAND OR
97227-1196
US

IV. Provider business mailing address

3550 N INTERSTATE AVE
PORTLAND OR
97227-1196
US

V. Phone/Fax

Practice location:
  • Phone: 503-249-3434
  • Fax:
Mailing address:
  • Phone: 503-249-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number200050043NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number025804AP30006101
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200050043
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200050043NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: