Provider Demographics
NPI:1003059882
Name:GILMORE, NANIS (RN, CDE)
Entity Type:Individual
Prefix:
First Name:NANIS
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 NE 20TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2862
Mailing Address - Country:US
Mailing Address - Phone:503-233-6940
Mailing Address - Fax:503-236-2676
Practice Address - Street 1:541 NE 20TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2862
Practice Address - Country:US
Practice Address - Phone:503-233-6940
Practice Address - Fax:503-236-2676
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081001531RN163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator