Provider Demographics
NPI:1609937283
Name:AMAREI, GABRIELLA (PMHNP)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:AMAREI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:P
Other - Last Name:KOVOLISKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:PO BOX 973
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-0973
Mailing Address - Country:US
Mailing Address - Phone:541-948-9243
Mailing Address - Fax:541-631-2599
Practice Address - Street 1:141 NW C ST STE E
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2035
Practice Address - Country:US
Practice Address - Phone:541-948-9243
Practice Address - Fax:541-631-2599
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR094006553N6363LP0808X
OR094006553N6 PMHNP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health