Provider Demographics
NPI:1346287075
Name:STERNKOPF HECKENBACH, GAIL M (CNM)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:STERNKOPF HECKENBACH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:M
Other - Last Name:EKLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1535 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4255
Mailing Address - Country:US
Mailing Address - Phone:503-364-3787
Mailing Address - Fax:503-763-3595
Practice Address - Street 1:1535 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4255
Practice Address - Country:US
Practice Address - Phone:503-364-3787
Practice Address - Fax:503-763-3595
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099007168NMNP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR099007168NMNPOtherSTATE LICENSE
OR297448Medicaid
OR099007168RNOtherSTATE LICENSE
ORP93796Medicare UPIN
OR297448Medicaid