Provider Demographics
NPI:1609396746
Name:SEXTON, MAGGIE MICHELE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:MICHELE
Last Name:SEXTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 SE TIBBETTS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2133
Mailing Address - Country:US
Mailing Address - Phone:816-803-2882
Mailing Address - Fax:
Practice Address - Street 1:2311 NW NORTHRUP ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2912
Practice Address - Country:US
Practice Address - Phone:816-803-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201702577NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner