Provider Demographics
NPI:1942912563
Name:DEVALPINE, MARIA GILSON (PMHNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GILSON
Last Name:DEVALPINE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:GILSON SISTROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN, PHD
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:
Mailing Address - Fax:
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-215-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR098006278RN163WP0808X
VA0024185761363LP0808X
OR202215296NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
15824500OtherCAQH ID