Individual
MARYAM SAUDAGARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
6350 NE HALSEY ST, PORTLAND, OR 97213-4720
(503) 215-2669
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60976395
WA
363L00000X
Nurse Practitioner
AP61297081
WA
363LG0600X
Gerontology Nurse Practitioner
Primary
10008586
OR
363LG0600X
Gerontology Nurse Practitioner
AP61297081
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2209323
—
WA
Enumeration date
02/24/2020
Last updated
11/02/2023
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