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General NPI Number Information
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NPI Number | 1447274337
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Entity Type | Individual
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Provider Name | MARY TOLLIVER GILLEY ANP-PP
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 1111 NE 99TH AVENUE
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City | PORTLAND
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State | OR
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Zip | 97220
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Country | US
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Telephone | 503-963-2707
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Fax | 503-963-2802
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Provider Business Mailing Address
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Address Line | 847 NE 19TH AVE SUITE 300
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City | PORTLAND
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State | OR
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Zip | 97232-2684
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Country | US
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Telephone | 503-963-2801
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Fax | 503-963-2825
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 200450144NP ANP-PP
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License Number State | OR
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