Healthcare Provider Details

I. General information

NPI: 1780627166
Provider Name (Legal Business Name): MARIA G. MALDONADO F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. MARY LEE GOW

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 WAITE ST SUITE1
NORTH BEND OR
97459-1229
US

IV. Provider business mailing address

4005 TORRINGTON AVE
EUGENE OR
97404-4077
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-6232
  • Fax: 541-756-6234
Mailing address:
  • Phone: 541-688-0710
  • Fax: 541-688-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number096006937N1 FNP PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: