MARGE L DETTWILER (NPI# 1053353649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053353649 |
| Entity Type | Individual |
| Full Name | MARGE L DETTWILER |
| Credential | PNP |
| Practice Address |
2395 Center St Ne Salem OR 97301-4464 |
| Practice Telephone | 5033640227 |
| Practice Fax Number | 5033640364 |
| Mailing Telephone | 5033640227 |
| Mailing Fax Number | 5033640364 |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2011-10-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
000027830N2 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 269714 | 05 |
| Street Address |
2395 CENTER ST NE |
| City | SALEM |
| State | OR |
| Zip Code | 97301-4464 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770525263 | Fara Katrina Etzel | Pediatrics | 2395 Center St Ne, Salem, OR 97301-4464 | 2006-06-11 |
| 1992731343 | James Kenneth Lace | Pediatrics | 2395 Center St Ne, Salem, OR 97301-4464 | 2006-06-25 |
| 1396781605 | Jon Michael Gilbert | Pediatrics | 2395 Center St Ne, Salem, OR 97301-4464 | 2006-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205450970 | Jehan Seals | Behavior Technician | 3400 State St Set G750, Salem, OR 97301 | 2020-05-29 |
| 1093335929 | Sterling Recovery, LLC | Dietitian, Registered | 3758 Amber St Ne #105, Salem, OR 97301 | 2020-04-21 |
| 1760018360 | Riverfront Mental Health LLC | Counselor | 338 State St, Suite 985, Salem, OR 97301 | 2020-03-16 |
| 1871126888 | Amity Beth Haddon Maxwell | Social Worker | Oregon State Hospital, 2600 Center St Ne, Salem, OR 97301 | 2020-02-18 |
| 1861042632 | Brenda Grizelda Vargas | Behavioral Analyst | 3400 State Ste Ste G750, Salem, OR 97301 | 2019-09-13 |
| 1588213177 | Natalie Stone | Registered Nurse | 2045 Siverton Rd Ne, Salem, OR 97301 | 2019-09-06 |
| 1588228720 | Jeramy Disenso | Counselor | 270 Cottage St Ne, Salem, OR 97301 | 2019-04-23 |
| 1801353297 | Gwendolyn Kersey | Registered Nurse | 2600 Center St Ne Oregon State Hospital, Salem, OR 97301 | 2019-02-21 |
| 1841769114 | Spine Clinic PC | Massage Therapist | 1281 Lancaster Drive Ne, Salem, OR 97301 | 2018-11-16 |
| 1013482132 | Kellie Linn Hansen | Physical Therapist | 4049 Market St Se, Salem, OR 97301 | 2018-10-04 |
| Find all providers in zip 97301 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194178376 | Amy Hodges | Nurse Practitioner | 172 Highway 62 W, Salem, AR 72576-8059 | 2016-07-22 |
| 1114930583 | Ingrid Scott | Nurse Practitioner | 11 Forrester St, Salem, MA 01970-4001 | 2006-08-15 |
| 1376539783 | Joseph Lee Easley | Nurse Practitioner | 1275 Hawthorn Rd, Salem, IL 62881-1028 | 2005-09-21 |
| 1225490816 | Melissa J Kohnen | Nurse Practitioner | 1275 Hawthorn Rd, Salem, IL 62881-1028 | 2016-03-23 |
| 1982077251 | Courtney Joy Kennison | Nurse Practitioner | 891 23rd St Ne, Salem, OR 97301-1793 | 2015-11-08 |
| 1093123382 | Elizabeth Cullinan | Nurse Practitioner | 84 Highland Ave, Salem, MA 01970-2727 | 2014-07-30 |
| 1790196244 | Lori Landreth | Nurse Practitioner | 1275 Hawthorn Rd, Salem, IL 62881-1028 | 2014-05-17 |
| 1649554049 | Jessica Lyn Joaquin | Nurse Practitioner | 72 Highland Ave, Salem, MA 01970-2738 | 2011-10-04 |
| 1952682676 | Katharine Chamberlin | Nurse Practitioner | 72 Highland Ave, Salem, MA 01970-2738 | 2011-09-08 |
| 1619206356 | Samantha Gunawardene | Nurse Practitioner | 72 Highland Ave, Salem, MA 01970-2738 | 2009-12-09 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.