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General NPI Number Information
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NPI Number | 1093345654
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Entity Type | Individual
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Provider Name | MICHELLE JENNY GOHL FNP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 3831 MAIN ST STE 108
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City | SPRINGFIELD
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State | OR
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Zip | 97478-5801
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Country | US
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Telephone | 877-522-1275
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Fax |
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Provider Business Mailing Address
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Address Line | 500 SW 7TH ST STE A205
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City | RENTON
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State | WA
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Zip | 98057-2983
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Country | US
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Telephone | 877-522-1275
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Fax | 833-888-7145
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201906642NP-PP
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License Number State | OR
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