MEDICARE: MRS. SUSAN MERIE COLEMER A-GNP-C

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	363LF0000X	Family Nurse Practitioner	10005870	OR
2	363L00000X	Nurse Practitioner	10005870	OR
3	163W00000X	Registered Nurse	234974	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	234974	OTHER	WI	REGISTERED NURSE

General Provider Information

NPI Number	:	1720787203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN MERIE COLEMER A-GNP-C

Provider Business Mailing Address
First Line	:	2976 CHAPEL VALLEY RD APT 101
Second Line	:
City	:	FITCHBURG
State	:	WI
Zip	:	53711-7417
Country	:	US
Telephone Number	:	608-445-3767
Fax Number	:

Provider Business Practice Location Address
First Line	:	16463 BOONES FERRY RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-4259
Country	:	US
Telephone Number	:	541-748-9634
Fax Number	:

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

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	12/31/2025

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Directions to “ MRS. SUSAN MERIE COLEMER A-GNP-C” Practice Location

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