MATTHEW DAVID FONTAINE (NPI# 1144515289) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144515289 |
| Entity Type | Individual |
| Full Name | MATTHEW DAVID FONTAINE |
| Credential | AAS |
| Practice Address |
13317 Se Powell Blvd Portland OR 97236-3335 |
| Mailing Address |
Po Box 8459 Portland OR 97207-8459 |
| Practice Telephone | 5037609606 |
| Practice Fax Number | 5037609609 |
| Mailing Telephone | 5032380769 |
| Mailing Fax Number | 5039637711 |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2011-06-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
201140738RN | OR | Nursing Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457400145 | Matthew Joseph Fontaine | Chiropractor | 113 N. Henry, Alexandria, VA 22314 | 2007-01-10 |
| Street Address |
13317 SE POWELL BLVD |
| City | PORTLAND |
| State | OR |
| Zip Code | 97236-3335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396857538 | Mark Scott Soine | Counselor | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2006-08-31 |
| 1174122782 | Kelvina Nicole Cornett | Technician | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2020-10-23 |
| 1841897105 | David Brian Prescott | Technician | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2020-10-08 |
| 1811501505 | Genalyn Inovejas Moore | Case Manager/Care Coordinator | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2020-09-01 |
| 1245844935 | Jacquelyn Boliba Soule | Technician | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2020-09-01 |
| 1407468085 | Elijah James Boone | Counselor | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2020-08-17 |
| 1386261055 | Maura Jean Ores Phillips | Technician | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2020-06-29 |
| 1649896051 | Cynthia E Ochoa Cavillo | Case Manager/Care Coordinator | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2020-06-22 |
| 1457976599 | Nicole Dawn Schmidlin | Case Manager/Care Coordinator | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2020-06-15 |
| 1790308302 | Alexander L Syum | Case Manager/Care Coordinator | 13317 Se Powell Blvd, Portland, OR 97236-3335 | 2020-05-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336650357 | Wondmimu Edao Chako | Registered Nurse | 3708 Se 144th Avenue, Portland, OR 97236 | 2017-10-17 |
| 1881142388 | John Ho | Pharmacist | 14700 Se Division St., Portland, OR 97236 | 2016-09-14 |
| 1306392527 | Lori-ann Lima | Nurse Practitioner | Multnomah County Health Department- Mid Cty Health Ctr, 12710 Se Division St, Portland, OR 97236 | 2016-08-28 |
| 1982096202 | Allan Fitzpatrick Beals-gibson | Adult Companion | 15602 Se Division St., Portland, OR 97236 | 2015-02-24 |
| 1386047132 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 3530 Se 136th Ave. #5, Portland, OR 97236 | 2014-10-07 |
| 1356750319 | Kendra Harding | Counselor | 17214 Se Division Street, Portland, OR 97236 | 2014-08-04 |
| 1659790400 | Nghia Tran | Pharmacist | 8438 Se 138th Dr, Portland, OR 97236 | 2014-04-09 |
| 1942623764 | Laurel Katherine Hallock Koppelman | Nurse Practitioner | 12720 Se Division Street, Portland, OR 97236 | 2014-01-30 |
| 1982046249 | Victoria D Lathrop | Massage Therapist | 17221 Se Divistion St S-21, Portland, OR 97236 | 2013-07-26 |
| 1669819694 | Ariann Von Vaughn | Dental Hygienist | 18011 Se Pershing Ct, Portland, OR 97236 | 2013-05-31 |
| Find all providers in zip 97236 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932747607 | Kendall Clayton Karch | Registered Nurse | 30 Ne Mlk Jr Blvd, Portland, OR 97232-2941 | 2019-12-12 |
| 1275810665 | Esther Gabrielle Rosengarten | Registered Nurse | 1020 Sw Taylor St Ste 745, Portland, OR 97205-2505 | 2011-11-14 |
| 1679890651 | Caroline Jones Redstone | Registered Nurse | 106 Sw Woods St, Portland, OR 97201-4739 | 2010-04-29 |
| 1053643775 | Diane Vines | Registered Nurse | 3880 Se 8th Ave, Suite 110, Portland, OR 97202-3772 | 2010-02-04 |
| 1013190081 | Kristin Lois Cummings | Registered Nurse | 5329 Ne Martin Luther King Blvd, Portland, OR 97211-3237 | 2007-12-12 |
| 1184818080 | Jacob Balinky | Registered Nurse | 3716 Ne Mlk Blvd, Portland, OR 97212-1111 | 2007-09-04 |
| 1467533778 | Patricia J. Osborne | Registered Nurse | 916 Sw King Ave, Suite 206, Portland, OR 97205-1303 | 2006-10-17 |
| 1780646430 | Marianne Decain Tarraza | Registered Nurse | 165 Lancaster St, Portland, ME 04101-2406 | 2006-04-06 |
| 1477162717 | Lynda Long | Registered Nurse | 847 Ne 19th Ave Ste 100, Portland, OR 97232-2684 | 2020-07-22 |
| 1447877352 | Shannon Barnicle | Registered Nurse | 62 Elm St, Portland, ME 04101-3091 | 2020-06-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.