MEDICARE: SUSAN BARNES

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1609957356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BARNES

Provider Business Mailing Address
First Line	:	5104 1/2 PLOMONDON ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98661-6192
Country	:	US
Telephone Number	:	360-521-8870
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 EDGEWATER ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-4049
Country	:	US
Telephone Number	:	503-588-5816
Fax Number	:	503-588-5803

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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Directions to “ SUSAN BARNES ” Practice Location

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