Provider Demographics
NPI:1710318654
Name:PURDY, MAREE ELIZABETH (ARNP)
Entity Type:Individual
Prefix:
First Name:MAREE
Middle Name:ELIZABETH
Last Name:PURDY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 SW GREENBURG RD STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5469
Mailing Address - Country:US
Mailing Address - Phone:503-293-4055
Mailing Address - Fax:503-293-8332
Practice Address - Street 1:10250 SW GREENBURG RD STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5469
Practice Address - Country:US
Practice Address - Phone:503-293-4055
Practice Address - Fax:503-293-8332
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60479342363LF0000X
OR201403441NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily