Healthcare Provider Details

I. General information

NPI: 1780128165
Provider Name (Legal Business Name): GORGE NP PARTNERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 DRY HOLLOW RD STE 4
THE DALLES OR
97058-3167
US

IV. Provider business mailing address

1015 WEBBER ST STE 100
THE DALLES OR
97058-3527
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-4804
  • Fax: 541-296-3741
Mailing address:
  • Phone: 541-296-4804
  • Fax: 541-296-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VALERIE ANN HIVELEY-BLATZ
Title or Position: OWNER
Credential: GNP
Phone: 541-296-4804