Provider Demographics
NPI:1154343077
Name:PRESS, MARK T (FNP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:T
Last Name:PRESS
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:600 SW COLUMBIA ST STE 6250
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1099
Mailing Address - Country:US
Mailing Address - Phone:541-383-3005
Mailing Address - Fax:541-383-1883
Practice Address - Street 1:2065 NE TUCSON WAY APT 110
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5182
Practice Address - Country:US
Practice Address - Phone:541-383-3005
Practice Address - Fax:541-383-1883
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-01-30
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Provider Licenses
StateLicense IDTaxonomies
OR098006225NIFNPPP207Q00000X
OR098006225N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR210689Medicaid
OR858381005OtherBLUE CROSS BLUE SHIELD
ORR134091Medicare PIN
ORH682516OtherPACIFIC SOUTH HEALTH PLAN
OR182960Medicaid
OR134091Medicare ID - Type Unspecified