Provider Demographics
NPI:1639368590
Name:DOBAJ, MANYA DIANE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:MANYA
Middle Name:DIANE
Last Name:DOBAJ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 NE TANASBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7836
Mailing Address - Country:US
Mailing Address - Phone:503-249-3434
Mailing Address - Fax:034-958-5235
Practice Address - Street 1:10315 NE TANASBOURNE DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7836
Practice Address - Country:US
Practice Address - Phone:503-249-3434
Practice Address - Fax:503-495-8523
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60021577363LP0808X
OR20050091NP2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA237498OtherL&I
WAP01290272OtherRR MEDICARE
WA8947886OtherCV
WA1639368590Medicaid
WA237498OtherL&I