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General NPI Number Information
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NPI Number | 1467881813
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Entity Type | Individual
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Provider Name | PETER C SUNDERLAND MSN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 409 NW 2ND AVE
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City | CANBY
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State | OR
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Zip | 97013-3517
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Country | US
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Telephone | 503-266-1407
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Fax |
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Provider Business Mailing Address
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Address Line | 30333 S CANDLELIGHT CT
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City | CANBY
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State | OR
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Zip | 97013-9567
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Country | US
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Telephone |
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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 | 201709514NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 201392795RN
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License Number State | OR
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