Provider Demographics
NPI:1316116684
Name:O'MAILIA, NINA (PA-C)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:
Last Name:O'MAILIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11507 SE FLAVEL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5985
Mailing Address - Country:US
Mailing Address - Phone:503-915-2090
Mailing Address - Fax:
Practice Address - Street 1:21900 WILLAMETTE DR STE 209
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3284
Practice Address - Country:US
Practice Address - Phone:971-274-0038
Practice Address - Fax:971-202-2099
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
ORPA152466363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8508384Medicaid
OR500604590Medicaid