Individual
MACKINLIE MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
615 S PALATINE HILL RD, PORTLAND, OR 97219-8091
(503) 768-7165
Mailing address
615 S PALATINE HILL RD, PORTLAND, OR 97219-8091
Taxonomy
Speciality
Code
Description
License number
State
163WC1400X
College Health Registered Nurse
Primary
202103350RN
OR
Other
Enumeration date
09/04/2024
Last updated
09/04/2024
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