Healthcare Provider Details

I. General information

NPI: 1053454355
Provider Name (Legal Business Name): MARGARET A PORTWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 NE WEST DEVILS LAKE ROAD COASTAL HEALTH PRACTITIONERS
LINCOLN CITY OR
97367-5131
US

IV. Provider business mailing address

3015 NE WEST DEVILS LAKE RD
LINCOLN CITY OR
97367-5131
US

V. Phone/Fax

Practice location:
  • Phone: 541-994-5591
  • Fax: 541-996-7294
Mailing address:
  • Phone: 541-994-5591
  • Fax: 541-994-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateOR

VIII. Authorized Official

Name: MARGARET A PORTWOOD
Title or Position: FNP
Credential: NP
Phone: 541-994-5591