Individual
MARILYN SOPHIA HARGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12710 SE DIVISION ST, PORTLAND, OR 97236-3134
(503) 988-3601
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3964
(503) 887-5665
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
201802206NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201802206NP
STATE LICENSE
OR
Enumeration date
01/03/2013
Last updated
01/24/2020
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