Provider Demographics
NPI:1508319922
Name:MOYERS, GAYLENE (CCMA)
Entity Type:Individual
Prefix:
First Name:GAYLENE
Middle Name:
Last Name:MOYERS
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1005
Mailing Address - Country:US
Mailing Address - Phone:541-524-9070
Mailing Address - Fax:541-524-9077
Practice Address - Street 1:3975 MIDWAY DRIVE
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1005
Practice Address - Country:US
Practice Address - Phone:541-524-9070
Practice Address - Fax:541-524-9077
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator