Healthcare Provider Details

I. General information

NPI: 1841737889
Provider Name (Legal Business Name): ZUBAIDA ABDULAI MACKLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ZUBAIDA AMADU ABDULAI

II. Dates (important events)

Enumeration Date: 01/29/2017
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863 SW HALL BLVD STE B
BEAVERTON OR
97005-2042
US

IV. Provider business mailing address

PO BOX 3777
PORTLAND OR
97208-3777
US

V. Phone/Fax

Practice location:
  • Phone: 503-519-9810
  • Fax: 703-977-3863
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201700299NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201700299
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201700299NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: