Individual
MRS. MARITZA LISSETTE VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
1060 WEBBER ST, THE DALLES, OR 97058-3749
(541) 993-8439
Mailing address
1060 WEBBER ST, THE DALLES, OR 97058-3749
(541) 993-8439
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
376K00000X
Nurse's Aide
Primary
201210419CNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201210419CNA
OREGON STATE BOARD OF NURSING
OR
Enumeration date
01/04/2021
Last updated
01/05/2021
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