Provider Demographics
NPI:1447080338
Name:REEBS, MARIA GUSENKOV (DNP-FNP)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:GUSENKOV
Last Name:REEBS
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:GUSENKOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13080 SW 107TH CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-3943
Mailing Address - Country:US
Mailing Address - Phone:925-818-3056
Mailing Address - Fax:
Practice Address - Street 1:12285 SW MAIN ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6221
Practice Address - Country:US
Practice Address - Phone:925-818-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10030824363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner