Healthcare Provider Details

I. General information

NPI: 1861376253
Provider Name (Legal Business Name): SUSAN W WARURU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 WAYMIRE ST NW
SALEM OR
97304-1803
US

IV. Provider business mailing address

1923 WAYMIRE ST NW
SALEM OR
97304-1803
US

V. Phone/Fax

Practice location:
  • Phone: 972-801-8814
  • Fax:
Mailing address:
  • Phone: 972-801-8814
  • Fax: 503-390-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number202104338RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number202104338RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: