MEDICARE: JANICE T CHUSSIL 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	174400000X	Specialist	090007375N3ANP-PP	OR

General Provider Information

NPI Number	:	1790997898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE T CHUSSIL ANP

Provider Business Mailing Address
First Line	:	9495 SW LOCUST ST
Second Line	:	STE A
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	503-636-9011
Fax Number	:	503-636-3952

Provider Business Practice Location Address
First Line	:	9495 SW LOCUST ST STE A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	503-445-2200
Fax Number	:	503-445-2201

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	01/19/2016

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Directions to “ JANICE T CHUSSIL ANP” Practice Location

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