Provider Demographics
NPI:1932567880
Name:MENCY, MARIE
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:MENCY
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 1:339 SW CENTURY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1338
Mailing Address - Country:US
Mailing Address - Phone:541-316-5693
Mailing Address - Fax:
Practice Address - Street 1:339 SW CENTURY DR STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1338
Practice Address - Country:US
Practice Address - Phone:541-316-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003289363LF0000X
CA772883163W00000X
OR202010478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty