Healthcare Provider Details

I. General information

NPI: 1841356136
Provider Name (Legal Business Name): GAYLE WIGINGTON POMROY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CENTER ST NE
SALEM OR
97301-4532
US

IV. Provider business mailing address

2300 BRUSH COLLEGE RD NW
SALEM OR
97304-9505
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5351
  • Fax: 503-585-4908
Mailing address:
  • Phone: 503-361-7882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number09007635RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: