Healthcare Provider Details

I. General information

NPI: 1265663058
Provider Name (Legal Business Name): SUZANN ADRIENNE GAGE APNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 CURRY RD
ROSEBURG OR
97471-8508
US

IV. Provider business mailing address

909 CURRY RD
ROSEBURG OR
97471-8508
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-0810
  • Fax: 541-802-0787
Mailing address:
  • Phone: 619-260-0810
  • Fax: 541-802-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number202102860NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN456541NP5830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: