Provider Demographics
NPI:1902863467
Name:CORCORAN, SUSAN A (FNP, CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21358 HIGHWAY 99E NE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OR
Mailing Address - Zip Code:97002-9201
Mailing Address - Country:US
Mailing Address - Phone:503-678-6269
Mailing Address - Fax:503-217-1599
Practice Address - Street 1:21358 HIGHWAY 99E NE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OR
Practice Address - Zip Code:97002-9201
Practice Address - Country:US
Practice Address - Phone:503-678-6269
Practice Address - Fax:503-217-1599
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350064NP NMNP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife