Healthcare Provider Details

I. General information

NPI: 1568472413
Provider Name (Legal Business Name): NANCY GUMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY THOMPSON

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

IV. Provider business mailing address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3513
  • Fax: 541-667-3454
Mailing address:
  • Phone: 541-667-3513
  • Fax: 541-667-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: