Healthcare Provider Details

I. General information

NPI: 1760676134
Provider Name (Legal Business Name): RENEE ARCHAMBAULT MARTIN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE MARIE ARCHAMBAULT

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

1622 N 8TH ST
WASHOUGAL WA
98671-8509
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax: 503-402-2808
Mailing address:
  • Phone: 360-835-8576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License NumberRN0015900
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: