Provider Demographics
NPI:1649154493
Name:MASTRUD, MARKUS (RN)
Entity type:Individual
Prefix:MR
First Name:MARKUS
Middle Name:
Last Name:MASTRUD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 SE SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9419
Mailing Address - Country:US
Mailing Address - Phone:206-406-4848
Mailing Address - Fax:
Practice Address - Street 1:5622 SE MEYERS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-6653
Practice Address - Country:US
Practice Address - Phone:503-502-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201909734RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health