Provider Demographics
NPI:1134142904
Name:THOMPSON, MARTIN MONTEL (MSN, FNPC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:MONTEL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MSN, FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40044 REUBEN LEIGH RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97452-9729
Mailing Address - Country:US
Mailing Address - Phone:541-607-7593
Mailing Address - Fax:541-607-7573
Practice Address - Street 1:100 RIVER AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2507
Practice Address - Country:US
Practice Address - Phone:541-607-7593
Practice Address - Fax:541-607-7573
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily