MARY KUEBRICH (NPI# 1477902617) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1477902617 |
Entity Type | Individual |
Full Name | MARY KUEBRICH |
Credential | AGPCNP |
Practice Address |
12442 Sw Scholls Ferry Rd Tigard OR 97223-3396 |
Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
Practice Telephone | 5032169200 |
Enumeration Date | 2016-06-08 |
Last Update Date | 2019-01-16 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
201604516NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
201604516NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
OR | 500709519 | 05 |
Street Address |
12442 SW SCHOLLS FERRY RD |
City | TIGARD |
State | OR |
Zip Code | 97223-3396 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1093135535 | Providence Health & Services - Oregon | Pediatrics | 12442 Sw Scholls Ferry Rd, Suite 205, Tigard, OR 97223-0804 | 2014-04-23 |
1730521311 | Melody Flannery | Physician Assistant | 12442 Sw Scholls Ferry Rd, Suite 106, Tigard, OR 97223-3396 | 2013-07-23 |
1841551041 | Thuy-tien Vo Pham | Internal Medicine | 12442 Sw Scholls Ferry Rd, Suite 100, Tigard, OR 97223-3396 | 2012-06-04 |
1699080259 | Sarah Reed | Physician Assistant | 12442 Sw Scholls Ferry Rd, Suite 100, Tigard, OR 97223-3396 | 2010-08-06 |
1891024907 | Mary Maher Olson | Pediatrics | 12442 Sw Scholls Ferry Rd, Suite 205, Tigard, OR 97223-3396 | 2009-12-18 |
1457597072 | Karla Ann Mcgee | Nurse Practitioner | 12442 Sw Scholls Ferry Rd, Suite 100, Tigard, OR 97223-3396 | 2009-01-02 |
1295983625 | Veronica Tiburcio-espinoza | Physician Assistant | 12442 Sw Scholls Ferry Rd, Suite 100, Tigard, OR 97223-3396 | 2008-08-27 |
1003019340 | Evagelia Baros | Internal Medicine | 12442 Sw Scholls Ferry Rd, Suite 106, Tigard, OR 97223-3396 | 2007-06-06 |
1720289283 | Maureen Matthews Gonzales | Physical Therapist | 12442 Sw Scholls Ferry Rd, 202, Tigard, OR 97223-3396 | 2007-05-30 |
1174724736 | Kathryn Anderson Carr | Physical Therapist | 12442 Sw Scholls Ferry Rd, Suite 202, Tigard, OR 97223-3396 | 2007-05-30 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760042618 | Tess Ivie Manso | Counselor | 8915 Degrees Center St, Tigard, OR 97223 | 2019-06-13 |
1780141804 | Amybrunermd LLC | Obstetrics & Gynecology | 6958 Sw Varns Street, Portland, OR 97223 | 2019-02-25 |
1417425034 | Patience Marie Rutto | Counselor | 8915 Sw Center Streret, Tigard, OR 97223 | 2018-11-13 |
1871089581 | Marina E Menegol | Behavioral Analyst | Center for Social Dynamics, 9115 Southwest Oleson Rd. Ste. 100, Portland, OR 97223 | 2018-07-05 |
1215423165 | Katherine Virginia Eichner | Psychologist | 9860 Sw Hall Blvd Ste B, Tigard, OR 97223 | 2018-07-03 |
1043717390 | Rayna Donnelly | Physician Assistant | 9735 Sw Shady Ln Ste 102, Tigard, OR 97223 | 2018-04-11 |
1376059725 | Kaylie Marilyn Reyes | Behavioral Analyst | 9115 Sw Oleson Road, Portland, OR 97223 | 2017-12-21 |
1841704004 | Kathleen Terrell Taylor | Occupational Therapist | 7320 Sw Hunziker, Suite 203, Tigard, OR 97223 | 2017-11-27 |
1487163036 | Susie Riess | Counselor | 10763 Sw Greenburg Road, Suite 100, Tigard, OR 97223 | 2017-09-27 |
1043731243 | Tam Nguyen | Optometrist | 8795 Sw Scholls Ferry Rd Ste 100, Tigard, OR 97223 | 2017-06-28 |
Find all providers in zip 97223 |
Taxonomy Code | 363LP2300X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Primary Care |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154956233 | Ellen Faye Barlow | Nurse Practitioner | 506 Fourth St., La Grande, OR 97850 | 2020-03-09 |
1225698889 | Agewell Geriatrics, LLC | Nurse Practitioner | 13120 Sw Heather Ct, Beaverton, OR 97008-5612 | 2019-06-17 |
1760960462 | Sid Christian Keomanivong | Nurse Practitioner | 2677 Beall Ln, Central Point, OR 97502-1462 | 2018-08-03 |
1245611771 | Karen Musick | Nurse Practitioner | 3514 Nw Mckinley Dr, Corvallis, OR 97330-1148 | 2015-06-10 |
1184054546 | Nancy M Burgess Rn Msn Anp-c PC | Nurse Practitioner | 910 Sw Highway 97 Ste 104, Madras, OR 97741-9247 | 2013-11-22 |
1518391804 | Sally Elizabeth Kraynik | Nurse Practitioner | 1895 E Main St, Hillsboro, OR 97123-4345 | 2013-08-22 |
1295998920 | Paula Jo Cramer | Nurse Practitioner | 790 S Main St Myrtle, Creek, Ore, Myrtle Creek, OR 97457 | 2008-07-02 |
1780855601 | Leslie West | Nurse Practitioner | 51730 Dexter St., Blue River, OR 97413-0183 | 2008-03-19 |
1548399322 | Corporate Health Nw | Nurse Practitioner | 10209 Se Division St, Portland, OR 97266-1327 | 2007-03-05 |
1962540310 | Laura Ann Shattuck | Nurse Practitioner | 21440 S Upper Highland Rd, Beavercreek, OR 97004-8814 | 2007-02-01 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.