Healthcare Provider Details

I. General information

NPI: 1740030881
Provider Name (Legal Business Name): AUDRA GILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NE 99TH AVE STE 200
PORTLAND OR
97220-9439
US

IV. Provider business mailing address

1321 NE 99TH AVE STE 200
PORTLAND OR
97220-9439
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-4250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number200941820RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: