Provider Demographics
NPI:1497897466
Name:MARTEL, MARY (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:MARTEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 SE HAWTHORNE BLVD STE 13060SE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4121
Mailing Address - Country:US
Mailing Address - Phone:855-235-0491
Mailing Address - Fax:
Practice Address - Street 1:3060 SE HAWTHORNE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4121
Practice Address - Country:US
Practice Address - Phone:855-235-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201703078163W00000X
WARN60743697163W00000X
WAAP60744184363L00000X
OR201703079363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse