=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215607890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE KRISTEN PURYEAR DNP-FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2021
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2255 NW SHEVLIN PARK RD STE 110
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97703-7134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-728-2525
-----------------------------------------------------
Fax | 503-917-4971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 NW LARCH AVE # 478
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97756-1357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-548-2164
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 202108794NP-PP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------