Marcia Bertalot, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

096006178N3 Issued in OR

Practice address

2701 NW Vaughn St
Portland, OR 97210-5311

Phone

(503) 499-5200

NPI assigned

Aug 25, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Marcia Gove Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1114035656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3633 NW 163RD TER",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970067245",
            "telephone_number": "503-645-1517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 NW VAUGHN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105311",
            "telephone_number": "503-499-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTALOT",
        "first_name": "MARCIA",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WA",
            "license": "AP30004275",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "096006178N3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbertalot1138982@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "6350 NE Halsey St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972134720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARCIA",
            "last_name": "GOVE",
            "credential": "ANP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel Wayne Berryman
• Angel Bershaw, CRNA
• Alexandra Jae Bershon
• Sara C Bersi Armstrong, LMT
• Joe Louis Bertagnolli, LCSW
• Jennifer S Bertapelle, LCSW
• Bertik Chiropractic Enterprises, LLC
• James Mark Bertola
• Andrea Marie Bertoni, PHARMD
• Elvira Bertrand

• Adult Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Adult Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.