Provider Demographics
NPI:1174620942
Name:MAHAR, LAURA TOPP (ANP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:TOPP
Last Name:MAHAR
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:TOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:STE 6N50
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-215-1350
Practice Address - Fax:503-215-1349
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080045359RN363LA2200X
OR080045359N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR124367Medicaid
P14877Medicare UPIN
ORR159217Medicare PIN
ORR159216Medicare PIN