Provider Demographics
NPI:1740831627
Name:MARTI, EDITH JOAN
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:JOAN
Last Name:MARTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SE 162ND AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-3866
Mailing Address - Country:US
Mailing Address - Phone:503-309-5148
Mailing Address - Fax:
Practice Address - Street 1:304 SE 162ND AVE APT 405
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-3866
Practice Address - Country:US
Practice Address - Phone:503-309-5148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant