Provider Demographics
NPI:1861610586
Name:ZARETSKY, SUSAN LORRAINE (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LORRAINE
Last Name:ZARETSKY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LORRAINE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:19260 SW 65TH AVE
Mailing Address - Street 2:SUITE 435
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-5701
Mailing Address - Country:US
Mailing Address - Phone:503-692-2032
Mailing Address - Fax:503-692-4450
Practice Address - Street 1:19260 SW 65TH AVE
Practice Address - Street 2:SUITE 435
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5701
Practice Address - Country:US
Practice Address - Phone:503-692-2032
Practice Address - Fax:503-692-4450
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250063NP FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000578Medicaid
WA1041268Medicaid
ORP64253Medicare UPIN
ORR148641Medicare PIN