Healthcare Provider Details

I. General information

NPI: 1114232576
Provider Name (Legal Business Name): ANDREW GERRY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18380 WILLAMETTE DR SUITE 202
WEST LINN OR
97068-1200
US

IV. Provider business mailing address

18380 WILLAMETTE DR SUITE 202
WEST LINN OR
97068-1200
US

V. Phone/Fax

Practice location:
  • Phone: 503-635-8384
  • Fax: 503-636-6475
Mailing address:
  • Phone: 503-635-8384
  • Fax: 503-636-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201050143NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: