SUSAN E WAGNER (NPI# 1588775357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588775357 |
| Entity Type | Individual |
| Full Name | SUSAN E WAGNER |
| Credential | PA-C |
| Practice Address |
4855 Sw Western Ave Beaverton OR 97005-3460 |
| Practice Telephone | 5036437565 |
| Mailing Telephone | 5036437565 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA00685 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811514722 | Susan Maxine Wagner | Nurse Practitioner | 103 Hilton Cir, Enterprise, AL 36330-7815 | 2020-06-26 |
| 1154672400 | Susan Wagner | Case Manager/Care Coordinator | 12 Lancaster Rd, Island Park, NY 11558-2136 | 2012-09-26 |
| 1134420185 | Susan Carol Wagner | Social Worker | 1108 Dithridge Dr, Johnstown, PA 15905-1503 | 2010-11-08 |
| 1467776781 | Susan Elizabeth Wagner | Marriage & Family Therapist | 79 Encinal Way, Ventura, CA 93001-3317 | 2010-03-15 |
| 1275768558 | Susan J Wagner | Community Health Worker | 278 John Tuttle Rd, New Kingston, NY 12459 | 2009-05-15 |
| 1437353976 | Susan Folmar Wagner | Counselor | 1040 Allegheny Ave Sw, Ocean Crest School, Bandon, OR 97411-9034 | 2007-06-11 |
| 1508089053 | Susan Wagner | Psychologist | 223 Katonah Ave Ste Ef, Katonah, NY 10536-2146 | 2007-04-11 |
| 1144337635 | Susan M Wagner | Physical Therapist | 85 Pleasant Dr, Hastings, MN 55033-1648 | 2006-08-23 |
| 1346695301 | Susan Rae Wagner | Nurse Practitioner | 142 Highland Dr, Lebanon, VA 24266-4636 | 2016-04-27 |
| 1679963482 | Susan Anglin Wagner | Counselor | 205 N Monroe St, Media, PA 19063-3052 | 2015-02-01 |
| Street Address |
4855 SW WESTERN AVE |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005-3460 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407827694 | Jennifer Mae Soyke | Family Medicine | 4855 Sw Western Ave, University of Oregon, Beaverton, OR 97005-3460 | 2006-01-27 |
| 1043857105 | Reagan Ravanzo Blanco | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-12-06 |
| 1144866591 | Asela Agtay Wells | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-11-20 |
| 1851935969 | Rosilyn Ricard | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-10-31 |
| 1063074789 | Blake Mcconnell | Student in an Organized Health Care Education/Training Program | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-07-02 |
| 1154886877 | Sarah Elizabeth Anderson Mills | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-02-06 |
| 1023506219 | Amanda Ellen Koonce | Student in an Organized Health Care Education/Training Program | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2018-04-24 |
| 1285142802 | Tiffani O'neill | Counselor | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2018-01-17 |
| 1912438953 | Dia Hazra | Pediatrics | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2017-03-22 |
| 1346782794 | Nicole Pollock | Pharmacist | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2016-11-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730787615 | Michael Hisao Mun Ho Pang | Physician Assistant | 1245 Sw 160th Ave, Beaverton, OR 97006-5052 | 2020-10-13 |
| 1427560663 | Megan Manley | Physician Assistant | 2935 Sw Cedar Hills Blvd, Beaverton, OR 97005-1342 | 2017-10-27 |
| 1982153417 | Adrienne Batla | Physician Assistant | 2725 Sw Cedar Hills Blvd Ste 200, Beaverton, OR 97005-1435 | 2016-09-26 |
| 1285182899 | Family Health & Wellness P.C. | Physician Assistant | 129 W Brown St, Beaverton, MI 48612-8119 | 2016-09-13 |
| 1659643534 | Ryan Thomas Gonce | Physician Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2012-02-07 |
| 1891805511 | Carolyn Jean Laviolette | Physician Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2006-08-30 |
| 1154436566 | Judy Ortiz | Physician Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2006-08-19 |
| 1083727507 | Jean-luc Louis Gustin | Physician Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2006-08-17 |
| 1194838896 | Robyn Lynn Triebold | Physician Assistant | 11200 Sw Murray Scholls Pl, Beaverton, OR 97007-9702 | 2006-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942808605 | Pilar Lorena Lopez | Physician Assistant | 7675 Sw Spruce St, Tigard, OR 97223-8723 | 2020-10-15 |
| 1144834805 | Logan Michael Johnston | Physician Assistant | 3319 Edgeview Ln, Forest Grove, OR 97116-1094 | 2020-09-01 |
| 1285255851 | Darby Samantha Jalbert | Physician Assistant | 2480 Liberty St Ne Ste 110, Salem, OR 97301-8381 | 2020-05-05 |
| 1033751433 | Trisha K Loch | Physician Assistant | 781 W Central, Sutherlin, OR 97479 | 2019-10-17 |
| 1154805729 | Ronald William Strohmeyer | Physician Assistant | 2327 S.w. 4th Ave, Ontario, OR 97914 | 2018-09-19 |
| 1740797166 | Joseph Something | Physician Assistant | 4800 Sw 76th Ave, Portland, OR 97225-1804 | 2018-01-08 |
| 1235687013 | Satchel Harry | Physician Assistant | 417 Sw 117th Ave Fl 2, Portland, OR 97225-5924 | 2016-09-21 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1659828044 | Ryan Jones | Physician Assistant | 1775 Thompson Rd Bay Or97420, Coos Bay, OR 97420-2125 | 2016-09-02 |
| 1922551910 | Ashley Crowell | Physician Assistant | 949 Nw Overton St Unit 306, Portland, OR 97209 | 2016-07-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SUSAN E WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.