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General NPI Number Information
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NPI Number | 1750267415
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Entity Type | Individual
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Provider Name | SUZANNE KELLY RN
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Gender | Female
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 19500 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97233-5757
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Country | US
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Telephone | 800-813-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1117
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City | RIDGEFIELD
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State | WA
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Zip | 98642-1117
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Country | US
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Telephone | 360-771-6222
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 201242664RN
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License Number State | OR
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