Healthcare Provider Details

I. General information

NPI: 1134155542
Provider Name (Legal Business Name): SUSAN M MITCHELL-MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9427 SW BARNES RD SUITE 395
PORTLAND OR
97225-6652
US

IV. Provider business mailing address

PO BOX 13994
PORTLAND OR
97213-0994
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-2602
  • Fax: 503-216-2639
Mailing address:
  • Phone: 503-214-6494
  • Fax: 503-215-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: