Provider Demographics
NPI:1013296490
Name:AGNEW, MARIE CASSELBERRY (FNP, DNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CASSELBERRY
Last Name:AGNEW
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:GAIL
Other - Last Name:CASSELBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:19075 NW TANASBOURNE DR.
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-941-3753
Mailing Address - Fax:
Practice Address - Street 1:929 SW SIMPSON AVE STE 300
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3599
Practice Address - Country:US
Practice Address - Phone:541-389-7741
Practice Address - Fax:541-278-8376
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201250123NP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily