Healthcare Provider Details

I. General information

NPI: 1376536656
Provider Name (Legal Business Name): JANET MENDEL-HARTVIG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE LL50
VANCOUVER WA
98664-1989
US

IV. Provider business mailing address

PO BOX 6039
PORTLAND OR
97208-6039
US

V. Phone/Fax

Practice location:
  • Phone: 360-449-4950
  • Fax:
Mailing address:
  • Phone: 360-254-2026
  • Fax: 360-253-8473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD22773
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: