MEDICARE: MS. SUSAN WADE CATO ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	94006372	OR

General Provider Information

NPI Number	:	1316929870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN WADE CATO ANP

Provider Business Mailing Address
First Line	:	5919 SE BELMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97215-1925
Country	:	US
Telephone Number	:	503-234-7366
Fax Number	:

Provider Business Practice Location Address
First Line	:	5919 SE BELMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97215-1925
Country	:	US
Telephone Number	:	503-234-7366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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