Healthcare Provider Details

I. General information

NPI: 1770771917
Provider Name (Legal Business Name): SUSAN GARSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CENTER ST NE
SALEM OR
97301-4532
US

IV. Provider business mailing address

2884 LAURELWOOD CT NW
SALEM OR
97304-1300
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5351
  • Fax: 503-585-4908
Mailing address:
  • Phone: 503-363-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: