Provider Demographics
NPI:1770275174
Name:CAVANAUGH, MARIA MORENO (RN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MORENO
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:GUADALUPE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4615 S VIRGINIA ST APT 15E
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-8032
Mailing Address - Country:US
Mailing Address - Phone:210-288-9809
Mailing Address - Fax:
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN1343277163WE0003X
TX794867163WE0003X
CA95315206163WE0003X
OR202209045RN163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency