Provider Demographics
NPI:1326717885
Name:PIGNOLET, MAYA GLENN
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:GLENN
Last Name:PIGNOLET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLENN
Other - Middle Name:
Other - Last Name:PIGNOLET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2316 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2316 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-4638
Practice Address - Country:US
Practice Address - Phone:971-303-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula