Healthcare Provider Details

I. General information

NPI: 1023569381
Provider Name (Legal Business Name): MARISA BELL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 11/07/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0110 SW BANCROFT ST STE B
PORTLAND OR
97239-4062
US

IV. Provider business mailing address

0110 SW BANCROFT ST STE B
PORTLAND OR
97239-4062
US

V. Phone/Fax

Practice location:
  • Phone: 971-328-1565
  • Fax: 206-385-7376
Mailing address:
  • Phone: 971-328-1565
  • Fax: 206-385-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60975936
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202002490NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: