Provider Demographics
NPI:1063725703
Name:VACARELLA, MARIA (CNM)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VACARELLA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3727 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1112
Mailing Address - Country:US
Mailing Address - Phone:503-775-4931
Mailing Address - Fax:503-788-7285
Practice Address - Street 1:2330 NE DIVISION ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3530
Practice Address - Country:US
Practice Address - Phone:503-775-4931
Practice Address - Fax:503-788-7285
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR201050134NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500624036Medicaid