Provider Demographics
NPI:1407161060
Name:CASTA MAH, JAIME LYN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LYN
Last Name:CASTA MAH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:LYN
Other - Last Name:CASTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C, ACNP-BC
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-7551
Mailing Address - Fax:503-494-4997
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-7551
Practice Address - Fax:503-494-4997
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050201NP363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care