Provider Demographics
NPI:1639316805
Name:GINGRAS, CHERYL A (MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:GINGRAS
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:GINGRAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8311
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950127NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily