Teresa Ann Martisak, RN CDE

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

086006602 Issued in OR

Practice address

1698 E McAndrews Rd
Suite 170
Medford, OR 97504-5589

Phone

(541) 732-6957

Fax

(541) 732-7901

NPI assigned

Apr 4, 2007

Last updated

Dec 4, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1225150741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "541-732-6957",
            "fax_number": "541-732-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1698 E MCANDREWS RD",
            "address_2": "SUITE 170",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045589",
            "telephone_number": "541-732-6957",
            "fax_number": "541-732-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTISAK",
        "first_name": "TERESA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "RN CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "OR",
            "license": "086006602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "086006602RN",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shilo Marie Martin, QMHA
• Stefanie Lynne Martin, MSW, LCSW
• Susan Bernier Martin, CDE/RN
• Cynthia Martinez
• Erika Martinez, CASE MANAGER
• Jessica N Marvin, LMT
• Dorothy Louise Marx
• Mary Lou Follett LLC
• Crystal Mary
• Sheri Lynn Masessa, OTRL

• Diabetes Educator Registered Nurse in Medford, OR
• Providers in Medford, OR by specialty
• Diabetes Educator Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.