Provider Demographics
NPI:1639509888
Name:TREMKO, MICHAEL P (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:TREMKO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CUMBERLAND XING # 279
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2356
Mailing Address - Country:US
Mailing Address - Phone:503-364-6093
Mailing Address - Fax:503-212-0209
Practice Address - Street 1:2250 D ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-364-6093
Practice Address - Fax:503-364-5121
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-24
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200842665RN163WP0808X
IN71012936A363LP0808X
WAAP61252566363LP0808X
ID69022363LP0808X
OR201502375NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health