Healthcare Provider Details

I. General information

NPI: 1154306009
Provider Name (Legal Business Name): MARIA NGUYEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19075 NW TANASBOURNE DR SUITE 200
HILLSBORO OR
97124-5860
US

IV. Provider business mailing address

PO BOX 5188
PORTLAND OR
97208-5188
US

V. Phone/Fax

Practice location:
  • Phone: 503-684-8252
  • Fax: 718-226-1039
Mailing address:
  • Phone: 888-227-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 156420
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number010077
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61118921
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: