Healthcare Provider Details

I. General information

NPI: 1902105406
Provider Name (Legal Business Name): TAMI MARIE MARTIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 NEHALEM BLVD.
WHEELER OR
97147
US

IV. Provider business mailing address

PO BOX 176
WHEELER OR
97147-0176
US

V. Phone/Fax

Practice location:
  • Phone: 800-368-5182
  • Fax: 844-712-3001
Mailing address:
  • Phone: 800-368-5182
  • Fax: 844-712-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201150134NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: