Provider Demographics
NPI:1437241460
Name:QUALE, CINDY LEE (P A)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:LEE
Last Name:QUALE
Suffix:
Gender:F
Credentials:P A
Other - Prefix:MISS
Other - First Name:CINDY
Other - Middle Name:LEE
Other - Last Name:MATANKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8550 NE BOEHMER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5142
Mailing Address - Country:US
Mailing Address - Phone:503-253-5709
Mailing Address - Fax:
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00465363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical