Marie Casselberry Agnew, FNP, DNP.
Individual provider Active NPI Nurse Practitioner · Bend, OR
NPI 1013296490 · NPPES record last updated Dec 28, 2018
Key facts
- NPI
- 1013296490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 201250123NP (OR)
- Practice address
- 929 SW Simpson Ave Ste 300
Bend, OR 97702-3599 - Phone
- (541) 389-7741
- Fax
- (541) 278-8376
- NPI assigned
- Aug 16, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
- Opted out of Medicare
- Yes, effective Jun 4, 2020 through Jun 4, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201250123NP | OR | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 201250123NP | OR | |
| Nurse Practitioner | 363L00000X | 201250123NP | OR | Yes |
Addresses
Primary practice location
929 SW Simpson Ave Ste 300
Bend, OR 97702-3599
Mailing address
19075 NW Tanasbourne Dr.
Hillsboro, OR 97214
Phone (503) 941-3753
Other practice location 1
2400 E Burnside St.
Portland, OR 97214
Phone (503) 608-3081
Other names
- Marie Gail Casselberry
Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.