Provider Demographics
NPI:1659478659
Name:DENNEY, GINGER A (FNP)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:A
Last Name:DENNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 12TH ST SE STE 260
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2153
Mailing Address - Country:US
Mailing Address - Phone:503-363-6520
Mailing Address - Fax:503-967-1472
Practice Address - Street 1:2525 12TH ST SE STE 260
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-363-6520
Practice Address - Fax:503-967-1472
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY30023.1143363LF0000X
OR201405164NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500678001Medicaid
ILP00437189OtherRAIL ROAD MEDICARE PIN
IL09015685OtherBLUE CROSS BLUE SHIELD
OR500678001Medicaid
IL09015685OtherBLUE CROSS BLUE SHIELD
IL$$$$$$$$$001Medicaid