Healthcare Provider Details

I. General information

NPI: 1447234901
Provider Name (Legal Business Name): SUSAN ELAINE HOFFMAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 SW MACADAM AVE HARBOR SQUARE SW, SUITE 260
PORTLAND OR
97239-3741
US

IV. Provider business mailing address

2838 SW DICKINSON ST
PORTLAND OR
97219-9211
US

V. Phone/Fax

Practice location:
  • Phone: 503-799-9519
  • Fax: 503-245-0518
Mailing address:
  • Phone: 503-245-9277
  • Fax: 503-245-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200250048NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: