Individual
LAWRENCE MALDONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201150188NP
OR
Other
Enumeration date
06/04/2012
Last updated
06/04/2012
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