Healthcare Provider Details

I. General information

NPI: 1609070929
Provider Name (Legal Business Name): AMY SUZANNE MARTENS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY SUZANNE GARDNER DO

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE NEFF RD
BEND OR
97701-6015
US

IV. Provider business mailing address

3900 S ZINTEL WAY
KENNEWICK WA
99337-5092
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-2651
  • Fax: 541-706-3765
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-942-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOP60233208
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1609070929
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier025904
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL&I GROUP #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: