Active NPI
Mary Jane Haake, CPCP
- Medical Art Specialist/Technologist
- Portland, OR
National Provider Identifier
1164791992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Art Specialist/Technologist
- License
- EPT-T-652245
- Practice address
- 1017 SW Morrison St
205
Portland, OR 97205-2635 - Phone
- (503) 224-8416
- Fax
- (503) 973-5433
- NPI assigned
- Dec 22, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Art Specialist/Technologist | 246ZA2600X | EPT-T-652245 | OR | Primary |
Addresses
Primary practice location
1017 SW Morrison St
205
Portland, OR 97205-2635
Mailing address
1017 SW Morrison St
205
Portland, OR 97205-2635
Phone (503) 224-8416
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| EPT-T-652245 | OR | MD | Medical Art Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324512000000",
"number": "1164791992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1017 SW MORRISON ST",
"address_2": "205",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052635",
"telephone_number": "503-224-8416",
"fax_number": "503-973-5433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1017 SW MORRISON ST",
"address_2": "205",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052635",
"telephone_number": "503-224-8416",
"fax_number": "503-973-5433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAAKE",
"first_name": "MARY",
"middle_name": "JANE",
"credential": "CPCP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-22",
"last_updated": "2011-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "246ZA2600X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Art, Medical",
"state": "OR",
"license": "EPT-T-652245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.