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General NPI Number Information
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NPI Number | 1396947065
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Entity Type | Individual
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Provider Name | SUSAN RUTH EKI PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 1217 NE BURNSIDE RD STE 503C
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City | GRESHAM
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State | OR
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Zip | 97030-5770
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Country | US
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Telephone | 971-888-2014
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Fax | 971-206-6387
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Provider Business Mailing Address
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Address Line | 644 SW WALTERS DR
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City | GRESHAM
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State | OR
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Zip | 97080-9351
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Country | US
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Telephone | 971-888-2014
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Fax | 971-206-6387
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 077037817N2
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 077037817N2
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 200250006NP
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License Number State | OR
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