Healthcare Provider Details

I. General information

NPI: 1316929870
Provider Name (Legal Business Name): SUSAN WADE CATO ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5919 SE BELMONT ST
PORTLAND OR
97215-1925
US

IV. Provider business mailing address

5919 SE BELMONT ST
PORTLAND OR
97215-1925
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-7366
  • Fax:
Mailing address:
  • Phone: 503-234-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number94006372
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: