Provider Demographics
NPI:1457499956
Name:GAETH, LINDA MARIE (ANP, PMHNP,MN, BC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:GAETH
Suffix:
Gender:F
Credentials:ANP, PMHNP,MN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 SW MACADAM
Mailing Address - Street 2:SUITE 358
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-244-0655
Mailing Address - Fax:503-242-0492
Practice Address - Street 1:5331 SW MACADAM AVE
Practice Address - Street 2:SUITE 358
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6104
Practice Address - Country:US
Practice Address - Phone:503-244-0655
Practice Address - Fax:503-242-0492
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0000366690N3363LA2200X
OR0000366690N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR068239Medicaid
ORS90659Medicare UPIN
105350Medicare ID - Type Unspecified