Provider Demographics
NPI:1760676134
Name:MARTIN, RENEE ARCHAMBAULT (RN, BSN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ARCHAMBAULT
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:MARIE
Other - Last Name:ARCHAMBAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1622 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-8509
Mailing Address - Country:US
Mailing Address - Phone:360-835-8576
Mailing Address - Fax:
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:503-402-2808
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN0015900163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology