Healthcare Provider Details

I. General information

NPI: 1841473907
Provider Name (Legal Business Name): GARY ALLEN GELARDO ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 NE COUCH ST
PORTLAND OR
97232-3067
US

IV. Provider business mailing address

1027 E BURNSIDE ST
PORTLAND OR
97214-1328
US

V. Phone/Fax

Practice location:
  • Phone: 503-239-8400
  • Fax: 503-239-8406
Mailing address:
  • Phone: 503-239-8400
  • Fax: 971-271-8268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number090006763N3
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number090006763N3 ANP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: