Individual provider Active NPI

Dennis Alberto Marquez, APRN

  • Gerontology Nurse Practitioner
  • Lake Oswego, OR
National Provider Identifier
1619564192
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
000202010828 Issued in OR
Practice address
5 Centerpointe Dr Ste 600
Lake Oswego, OR 97035-8662
Phone
(503) 603-7355
NPI assigned
Dec 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 000202010828 OR Primary

Addresses

Primary practice location

5 Centerpointe Dr Ste 600
Lake Oswego, OR 97035-8662

Mailing address

1 Jefferson Pkwy Apt 63
Lake Oswego, OR 97035-8806
Phone (813) 335-6993

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210204000056 OR Order and Referring Only - Nurse Practitioner 5597179424

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
000202010828ORMDGerontology Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1619564192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 JEFFERSON PKWY APT 63",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970358806",
            "telephone_number": "813-335-6993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CENTERPOINTE DR STE 600",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970358662",
            "telephone_number": "503-603-7355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARQUEZ",
        "first_name": "DENNIS",
        "middle_name": "ALBERTO",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-30",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OR",
            "license": "000202010828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

Verify at the official NPI Registry.