Provider Demographics
NPI:1497497465
Name:KANYERE, MASIKA JULIET
Entity Type:Individual
Prefix:
First Name:MASIKA
Middle Name:JULIET
Last Name:KANYERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 SE 169TH AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-7314
Mailing Address - Country:US
Mailing Address - Phone:503-847-5730
Mailing Address - Fax:
Practice Address - Street 1:493 SE 169TH AVE APT 213
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-7314
Practice Address - Country:US
Practice Address - Phone:503-847-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula