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NPI Code Detail

MEDICARE: MRS. GAYLE MARGARET MORAN ADULT NURSE PRACTITI

MEDICARE: MRS. GAYLE MARGARET MORAN ADULT NURSE PRACTITI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner098006088N3 ANP-PPOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2GM01 067593003OTHERORBLUE CROSS/SHIELD PIN

General Provider Information

NPI Number : 1912941667
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GAYLE MARGARET MORAN ADULT NURSE PRACTITI
Provider Business Mailing Address
First Line : 5100 SW MACADAM AVE
Second Line : SUITE 200
City : PORTLAND
State : OR
Zip : 97239-6102
Country : US
Telephone Number : 971-202-5500
Fax Number : 971-202-5555
Provider Business Practice Location Address
First Line : 5100 SW MACADAM AVE
Second Line : SUITE 200
City : PORTLAND
State : OR
Zip : 97239-6102
Country : US
Telephone Number : 971-202-5500
Fax Number : 971-202-5555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 01/23/2013

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Directions to “ MRS. GAYLE MARGARET MORAN ADULT NURSE PRACTITI” Practice Location

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