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General NPI Number Information
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NPI Number | 1558812867
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Entity Type | Individual
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Provider Name | GWEN SAMPSON
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Gender | Female
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 6800 SW 105TH AVE STE 206
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City | BEAVERTON
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State | OR
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Zip | 97008-5487
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Country | US
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Telephone | 503-430-1777
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Fax | 503-372-5119
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Provider Business Mailing Address
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Address Line | 6800 SW 105TH AVE STE 206
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City | BEAVERTON
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State | OR
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Zip | 97008-5487
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Country | US
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Telephone | 503-430-1777
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Fax | 503-372-5119
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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 | 26NJ00678600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ00678600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 201703018NP-PP
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License Number State | OR
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