Provider Demographics
NPI:1033151667
Name:MAKLER, ELISABETH HAYDEN HOLT (WHCNP, ANP)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:HAYDEN HOLT
Last Name:MAKLER
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Gender:F
Credentials:WHCNP, ANP
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Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-292-3577
Mailing Address - Fax:503-292-3947
Practice Address - Street 1:9555 SW BARNES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6663
Practice Address - Country:US
Practice Address - Phone:503-292-3577
Practice Address - Fax:503-292-3947
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR200550107NP363LA2200X
WAAP30007105363LA2200X, 363LW0102X
OR200550108NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278822Medicaid
ORR186769OtherMEDICARE PTAN
WA9656042Medicaid