Healthcare Provider Details

I. General information

NPI: 1285385922
Provider Name (Legal Business Name): MARIAM HAMEED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 NE IRVING AVE
BEND OR
97701-4738
US

IV. Provider business mailing address

711 NE IRVING AVE
BEND OR
97701-4738
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-9110
  • Fax: 541-330-9112
Mailing address:
  • Phone: 541-330-9110
  • Fax: 541-330-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32691
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10007705
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number257309
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10007705
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: