Provider Demographics
NPI:1780627166
Name:MALDONADO, MARIA G (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:G
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:LEE
Other - Last Name:GOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4005 TORRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-4077
Mailing Address - Country:US
Mailing Address - Phone:541-688-0710
Mailing Address - Fax:541-688-0710
Practice Address - Street 1:1890 WAITE ST
Practice Address - Street 2:SUITE1
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1229
Practice Address - Country:US
Practice Address - Phone:541-756-6232
Practice Address - Fax:541-756-6234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096006937N1 FNP PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137872Medicaid
P49224Medicare UPIN