Healthcare Provider Details

I. General information

NPI: 1912239146
Provider Name (Legal Business Name): DONNA MARIE GILMORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 05/01/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 SW ELKHORN AVE
REDMOND OR
97756-1847
US

IV. Provider business mailing address

4555 SW ELKHORN AVE
REDMOND OR
97756-1847
US

V. Phone/Fax

Practice location:
  • Phone: 541-504-3600
  • Fax:
Mailing address:
  • Phone: 541-504-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN00172019
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201040492RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number201040492RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: