Healthcare Provider Details

I. General information

NPI: 1861355836
Provider Name (Legal Business Name): LENDELL MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 HILLCREST PARK DR
MEDFORD OR
97504-7657
US

IV. Provider business mailing address

3265 HILLCREST PARK DR
MEDFORD OR
97504-7657
US

V. Phone/Fax

Practice location:
  • Phone: 541-236-0124
  • Fax: 541-610-1629
Mailing address:
  • Phone: 541-236-0124
  • Fax: 541-610-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10058216
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: