Provider Demographics
NPI:1912358730
Name:MARTELL, SUSANNAH (FNP)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:MARTELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3896 BEVERLY AVE NE
Mailing Address - Street 2:BLDG J, SUITE 40
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1374
Mailing Address - Country:US
Mailing Address - Phone:503-588-0076
Mailing Address - Fax:503-588-0531
Practice Address - Street 1:3896 BEVERLY AVE NE
Practice Address - Street 2:BLDG J, SUITE 40
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1374
Practice Address - Country:US
Practice Address - Phone:503-588-0076
Practice Address - Fax:503-588-0531
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201606933NP-PP363LF0000X
OR099000190RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse