Provider Demographics
NPI:1619371622
Name:GAINES, CARLI (RN, LAC)
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:CARLI
Other - Middle Name:
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, LAC
Mailing Address - Street 1:1744 NE TAURUS CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6472
Mailing Address - Country:US
Mailing Address - Phone:541-797-9962
Mailing Address - Fax:541-610-1557
Practice Address - Street 1:151 SW SHEVLIN HIXON DR STE 101
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3232
Practice Address - Country:US
Practice Address - Phone:541-797-3412
Practice Address - Fax:541-610-1557
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200841742RN163W00000X
ORAC169497171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse