Provider Demographics
NPI:1558654178
Name:DR N GYN
Entity Type:Organization
Organization Name:DR N GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALISBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-908-1646
Mailing Address - Street 1:17020 PILKINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5352
Mailing Address - Country:US
Mailing Address - Phone:503-908-1646
Mailing Address - Fax:503-908-1648
Practice Address - Street 1:17020 PILKINGTON RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5352
Practice Address - Country:US
Practice Address - Phone:503-908-1646
Practice Address - Fax:503-908-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13666207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR162370Medicaid
OR162370Medicaid