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General NPI Number Information
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NPI Number | 1710033782
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Entity Type | Individual
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Provider Name | MARY THERESE MARCY ANP
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7122 SE SHORT RD
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City | GRESHAM
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State | OR
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Zip | 97080-9094
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Country | US
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Telephone | 503-663-7172
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Fax |
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Provider Business Mailing Address
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Address Line | 7122 SE SHORT RD
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City | GRESHAM
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State | OR
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Zip | 97080-9094
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Country | US
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Telephone | 503-663-7172
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP30007622
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 078040195ANPPP
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License Number State | OR
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