Healthcare Provider Details

I. General information

NPI: 1730391665
Provider Name (Legal Business Name): JAMIE MAHONEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 NE STUCKI AVE
HILLSBORO OR
97124
US

IV. Provider business mailing address

6854 NE WILLOWGROVE ST
HILLSBORO OR
97124-8098
US

V. Phone/Fax

Practice location:
  • Phone: 971-413-8027
  • Fax:
Mailing address:
  • Phone: 720-323-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number150728
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: