Provider Demographics
NPI:1619558020
Name:MARTINEZ, ALYSSA ANNE (APRN,CNM)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:ANNE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:APRN,CNM
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ANNE
Other - Last Name:MATUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7650 SW BEVELAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-601-3615
Mailing Address - Fax:503-840-3299
Practice Address - Street 1:9701 SW BARNES RD STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6689
Practice Address - Country:US
Practice Address - Phone:503-734-3700
Practice Address - Fax:503-473-8462
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202110337NP-PP367A00000X
NV846457367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife