Healthcare Provider Details

I. General information

NPI: 1588721237
Provider Name (Legal Business Name): YVETTE M GAYNOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/29/2021
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NE MEDICAL CENTER DR
BEND OR
97701-6051
US

IV. Provider business mailing address

1501 NE MEDICAL CENTER DR
BEND OR
97701-6051
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-2811
  • Fax:
Mailing address:
  • Phone: 541-382-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200550094 FNP PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: