Provider Demographics
NPI:1023276474
Name:MORIARTY, DONNA JEAN (RN)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5424 SE BUSH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2932
Mailing Address - Country:US
Mailing Address - Phone:503-705-5892
Mailing Address - Fax:
Practice Address - Street 1:5424 SE BUSH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2932
Practice Address - Country:US
Practice Address - Phone:503-705-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000025761RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health