Healthcare Provider Details

I. General information

NPI: 1023276474
Provider Name (Legal Business Name): DONNA JEAN MORIARTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA JEAN SCHAEFER RN

II. Dates (important events)

Enumeration Date: 05/31/2008
Last Update Date: 05/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 SE BUSH ST
PORTLAND OR
97206-2932
US

IV. Provider business mailing address

5424 SE BUSH ST
PORTLAND OR
97206-2932
US

V. Phone/Fax

Practice location:
  • Phone: 503-705-5892
  • Fax:
Mailing address:
  • Phone: 503-705-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number000025761RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: