Healthcare Provider Details

I. General information

NPI: 1629010574
Provider Name (Legal Business Name): GAYLE MELINDA MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 SE BELMONT ST SUITE 60
PORTLAND OR
97215-1752
US

IV. Provider business mailing address

418 NE BRIDGETON RD
PORTLAND OR
97211-1051
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5303
  • Fax: 503-988-5112
Mailing address:
  • Phone: 503-539-7884
  • Fax: 503-988-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number093007089N1 FNP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: