Basic Information
| Provider Information | |||||||||
| NPI: | 1033151667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAKLER | ||||||||
| FirstName: | ELISABETH | ||||||||
| MiddleName: | HAYDEN HOLT | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | WHCNP, ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7650 SW BEVELAND RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032923577 | ||||||||
| FaxNumber: | 5032923947 | ||||||||
| Practice Location | |||||||||
| Address1: | 9555 SW BARNES RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032923577 | ||||||||
| FaxNumber: | 5032923947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 200550107NP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | AP30007105 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LW0102X | 200550108NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LW0102X | AP30007105 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 278822 | 05 | OR | MEDICAID | R186769 | 01 | OR | MEDICARE PTAN | OTHER | 9656042 | 05 | WA | MEDICAID |