Healthcare Provider Details

I. General information

NPI: 1063461242
Provider Name (Legal Business Name): CATIA HELENA GARGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 05/06/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 12TH ST SE STE 260
SALEM OR
97302-2282
US

IV. Provider business mailing address

2370 CORPORATE CIR STE 300
HENDERSON NV
89074-7760
US

V. Phone/Fax

Practice location:
  • Phone: 971-701-9058
  • Fax:
Mailing address:
  • Phone: 702-910-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200750082NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: