Provider Demographics
NPI:1063711398
Name:STROM, MAYA (FNP-C, DNP)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:STROM
Suffix:
Gender:F
Credentials:FNP-C, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 SE BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1925
Mailing Address - Country:US
Mailing Address - Phone:541-638-0870
Mailing Address - Fax:833-390-1391
Practice Address - Street 1:5935 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1925
Practice Address - Country:US
Practice Address - Phone:541-630-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201250074NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2049718Medicaid
OR500648815Medicaid
OR184452Medicare PIN