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General NPI Number Information
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NPI Number | 1174687479
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Entity Type | Individual
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Provider Name | KATHARINE GAGE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 2006 SE ANKENY ST
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City | PORTLAND
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State | OR
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Zip | 97214-1622
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Country | US
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Telephone | 503-502-3994
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Fax | 503-288-6760
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Provider Business Mailing Address
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Address Line | 8865 SW WHITE PINE LN
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City | PORTLAND
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State | OR
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Zip | 97225-2447
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Country | US
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Telephone | 503-292-6495
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 080046020
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License Number State | OR
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