Provider Demographics
NPI:1891982286
Name:SUITER, JAMES EDWARD (FNP-BC / GNP-BC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:SUITER
Suffix:
Gender:M
Credentials:FNP-BC / GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4628
Mailing Address - Country:US
Mailing Address - Phone:541-914-6421
Mailing Address - Fax:503-905-0897
Practice Address - Street 1:4560 SE INTERNATIONAL WAY STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4628
Practice Address - Country:US
Practice Address - Phone:541-914-6421
Practice Address - Fax:503-905-0897
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750074NP363LG0600X
OR200750074NP FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241776Medicaid
OR200880005DPOtherOREGON STATE BOARD OF NURSING DISPENSING PRIVELAGES
OR200750074NP FNP-PPOtherOREGON STATE BOARD OF NURSING --FNP
ORLIPA:JAMES E. SUITEROtherLIPA
12260994OtherCAQH
DCMS1629267OtherDEA: SCHEDULES 2, 2N, 3, 3N, 4, 5
ORLIPA:JAMES E. SUITEROtherLIPA