Healthcare Provider Details

I. General information

NPI: 1134481948
Provider Name (Legal Business Name): SUSAN WOODS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 SKYLINE RD S
SALEM OR
97306-9427
US

IV. Provider business mailing address

2062 SUNRAY CIR
WEST LINN OR
97068-4802
US

V. Phone/Fax

Practice location:
  • Phone: 503-361-5400
  • Fax:
Mailing address:
  • Phone: 503-347-5258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number000036342RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: