Provider Demographics
NPI:1043580822
Name:MARTINHORST, JANINE MARIE (NTP)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:MARTINHORST
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8760 S GRIZZLY BEAR DR
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-9554
Mailing Address - Country:US
Mailing Address - Phone:503-539-1567
Mailing Address - Fax:
Practice Address - Street 1:8760 S GRIZZLY BEAR DR
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-9554
Practice Address - Country:US
Practice Address - Phone:503-539-1567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
000994133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education