Provider Demographics
NPI:1144266362
Name:WEGELT HEINZ, SUSAN J (CNM, NP)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:WEGELT HEINZ
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Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2314 NW KINGS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3925
Mailing Address - Country:US
Mailing Address - Phone:541-286-4030
Mailing Address - Fax:541-286-4158
Practice Address - Street 1:2314 NW KINGS BLVD
Practice Address - Street 2:STE A
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3925
Practice Address - Country:US
Practice Address - Phone:541-286-4030
Practice Address - Fax:541-286-4158
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR087006416RN/N5367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS33410Medicare UPIN