Provider Demographics
NPI:1114783396
Name:GRESHAM WOMEN'S HEALTH LLC
Entity Type:Organization
Organization Name:GRESHAM WOMEN'S HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NIKKIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:503-459-7496
Mailing Address - Street 1:515 NE ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7307
Mailing Address - Country:US
Mailing Address - Phone:503-477-2478
Mailing Address - Fax:
Practice Address - Street 1:515 NE ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7307
Practice Address - Country:US
Practice Address - Phone:503-477-2478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty