Provider Demographics
NPI:1023348091
Name:KOSKI-VOGT, MARY MEGAN WILKINSON (RN, CNM)
Entity type:Individual
Prefix:
First Name:MARY MEGAN
Middle Name:WILKINSON
Last Name:KOSKI-VOGT
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:MARY MEGAN
Other - Middle Name:WILKINSON
Other - Last Name:KOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7650 SW BEVELAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-601-3615
Mailing Address - Fax:503-646-1683
Practice Address - Street 1:19250 SW 65TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7707
Practice Address - Country:US
Practice Address - Phone:503-692-1242
Practice Address - Fax:503-691-3615
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950158NP NMNP-PP367A00000X, 367A00000X
NMRN-73292163W00000X
NM621367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500617865Medicaid
ORR174294OtherMEDICARE PTAN