Provider Demographics
NPI:1619971652
Name:PORTWOOD, MARGARET A
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:PORTWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:PORTWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:3015 NE WEST DEVILS LAKE ROAD
Mailing Address - Street 2:COASTAL HEALTH PRACTITIONERS
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367
Mailing Address - Country:US
Mailing Address - Phone:541-994-5591
Mailing Address - Fax:541-994-3735
Practice Address - Street 1:3015 NE WEST DEVILS LAKE ROAD
Practice Address - Street 2:COASTAL HEALTH PRACTITIONERS
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367
Practice Address - Country:US
Practice Address - Phone:541-994-5591
Practice Address - Fax:541-996-7294
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2024-03-14
Deactivation Date:2007-02-15
Deactivation Code:
Reactivation Date:2007-02-16
Provider Licenses
StateLicense IDTaxonomies
OR000031726N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR221200Medicaid
ORANP0068OtherWORKERS COMPENSATION
OR221200Medicaid
ORANP0068OtherWORKERS COMPENSATION
0000XCBBGMedicare ID - Type Unspecified