Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 18370 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201050104NP | OR |
NPI | 1003064304 |
---|---|
Provider Name | Susan Ranae Battle |
First Address | Lake Oswego, OR 97035-8651 |
Second Address | Lake Oswego, OR 97035-8651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2008 |
Last Update Date | 28/03/2016 |