Individual
KAITANA MARTINEZ DAHLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
896 FORTNER ST, ONTARIO, OR 97914-1787
(541) 881-2828
Mailing address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-7364
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
202204058RN
OR
163W00000X
Registered Nurse
72647
ID
163W00000X
Registered Nurse
RN.485483
OH
363LF0000X
Family Nurse Practitioner
202207545NP-PP
OR
363LF0000X
Family Nurse Practitioner
Primary
72647
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500808728
—
OR
Enumeration date
03/23/2022
Last updated
01/13/2026
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