Individual
MRS. TERESA ANN MARTISAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CDE
Contact information
Practice address
1698 E MCANDREWS RD, SUITE 170, MEDFORD, OR 97504-5589
(541) 732-6957
(541) 732-7901
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 732-6957
(541) 732-7901
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
086006602
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
086006602RN
RN LICENSE
OR
Enumeration date
04/04/2007
Last updated
12/04/2012
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