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General NPI Number Information
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NPI Number | 1255453437
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Entity Type | Individual
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Provider Name | SUSAN JILL HAZEL PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15100 BOONES FERRY RD #700
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3469
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Country | US
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Telephone | 503-330-5092
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Fax | 503-892-3129
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Provider Business Mailing Address
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Address Line | PO BOX 13510 MHPBS
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City | PORTLAND
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State | OR
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Zip | 97213
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Country | US
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Telephone | 503-249-0181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 000036739N6
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License Number State | OR
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