Provider Demographics
NPI:1144642901
Name:PURDY, MARY (PBP, BSN, RES-CPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PURDY
Suffix:
Gender:F
Credentials:PBP, BSN, RES-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WOODLAND DR NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-8710
Mailing Address - Country:US
Mailing Address - Phone:503-910-1045
Mailing Address - Fax:
Practice Address - Street 1:104 S WATER ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1641
Practice Address - Country:US
Practice Address - Phone:503-910-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099000160RN163WL0100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant