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General NPI Number Information
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NPI Number | 1316488620
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Entity Type | Individual
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Provider Name | GLORIA SIM LE FNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 1001 SW DISK DR STE 250
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City | BEND
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State | OR
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Zip | 97702-3754
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Country | US
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Telephone | 541-293-1325
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Fax | 541-229-1314
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Provider Business Mailing Address
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Address Line | 1001 SW DISK DR STE 250
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City | BEND
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State | OR
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Zip | 97702-3754
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Country | US
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Telephone | 541-293-1325
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Fax | 510-379-9209
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 202109330RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 202109331NP-PP
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95006055
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95006055
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 202109331NP-PP
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License Number State | OR
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