Provider Demographics
NPI:1881927549
Name:ZAMORA, WENDY (PMHNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12655 SW CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1600
Mailing Address - Country:US
Mailing Address - Phone:503-457-5012
Mailing Address - Fax:503-430-8125
Practice Address - Street 1:12655 SW CENTER ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-457-5012
Practice Address - Fax:503-430-8125
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR092000169RN163W00000X
OR201608741NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse