Rivard-Dibenedetto, Susan E

Rivard-Dibenedetto, Susan E is an individual health care provider with primary practice located at 2850 Se Powell Valley Rd , Gresham OR 97080-1494. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Rivard-Dibenedetto, Susan E can be contacted via phone (503) 666-5050.

Contact Information

Primary practice address
2850 Se Powell Valley Rd Gresham OR 97080-1494
Phone: (503) 666-5050
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA10003271 Washington
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA151129 Oregon

Profile Details

NPI number 1265493399
LBN Legal business name Rivard-Dibenedetto, Susan E
Credentials PA C
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 29th, 2006
Last updated Feb 10th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265493399 NPPES
Washington MEDICAID 8377012

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