Basic Information
| Provider Information | |||||||||
| NPI: | 1730233453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALISBURY | ||||||||
| FirstName: | MARGO | ||||||||
| MiddleName: | RALL | ||||||||
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| Credential: | WHCNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 SW OAK ST | ||||||||
| Address2: | 210 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972041817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039883674 | ||||||||
| FaxNumber: | 5039885185 | ||||||||
| Practice Location | |||||||||
| Address1: | 426 SW STARK ST | ||||||||
| Address2: | 8TH FLOOR | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972042347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039883674 | ||||||||
| FaxNumber: | 5039885185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 12/18/2009 | ||||||||
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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 | 000028732N3 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LW0102X | 000028732N7 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 022959 | 05 | OR | MEDICAID |