Maryan Abdulkadir
Individual provider Active NPI Nurse Practitioner · Portland, OR
NPI 1295447654 · NPPES record last updated Oct 1, 2025
Key facts
- NPI
- 1295447654
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 10050196 (OR)
- Practice address
- 12710 SE Division St
Portland, OR 97236-3134 - Phone
- (503) 988-5558
- NPI assigned
- Dec 16, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Oregon Health Sciences University School of Medicine, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Multnomah County
Practice addresses (Care Compare)
12710 SE Division
Mid County Health Center
Portland, OR 97236-3134
Phone (503) 988-3601
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251014002346 | OR | Practitioner - Nurse Practitioner | 8325535339 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10050196 | OR | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Multnomah County | Current |
Accepting new patients | |
| Multnomah County | Current |
Accepting new patients | |
| Multnomah County | Single Specialty | Current | Accepting new patients |
Locations
600 NE 8th St
Gresham, OR 97030
Phone (503) 988-4900
209 SW 4th Ave
Ste 210
Portland, OR 97204
Phone (503) 988-3674
12710 SE Division St
Portland, OR 97236
Phone (503) 988-3410
619 NW 6th Ave
Fl 5
Portland, OR 97209
Phone (503) 988-3674
Interoperability endpoints
- mabdulkadir744641@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | 10050196 | OR | Yes |
Addresses
Primary practice location
12710 SE Division St
Portland, OR 97236-3134
Mailing address
12710 SE Division St
Portland, OR 97236-3134
Phone (503) 988-5558
Other providers in Portland, OR
- Halima Abdirazak
- Noor Abdirazak
- Gemechis Abdissa
- Abdul Munir Abdul Ghiyas
- Mohammad Malin Abdulaziz
- Abdulkadir Sharif Abdullahi
- Adnan Abdullahi
- Lul Abdullahi
- Fowzia Abdulle
- Obada Abdulrazzak
All providers in Portland, OR · Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.