Provider Demographics
NPI:1841737889
Name:MACKLEY, ZUBAIDA ABDULAI (FNP)
Entity Type:Individual
Prefix:
First Name:ZUBAIDA
Middle Name:ABDULAI
Last Name:MACKLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ZUBAIDA
Other - Middle Name:AMADU
Other - Last Name:ABDULAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3777
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3777
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:3863 SW HALL BLVD STE B
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2042
Practice Address - Country:US
Practice Address - Phone:503-519-9810
Practice Address - Fax:703-977-3863
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201700299NP-PP363L00000X, 363LF0000X
OR201700299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500723390Medicaid