Provider Demographics
NPI:1932103850
Name:GAIN, TINA M (CNM)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:GAIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9470
Mailing Address - Country:US
Mailing Address - Phone:541-997-7134
Mailing Address - Fax:541-902-1320
Practice Address - Street 1:380 NINTH STREET
Practice Address - Street 2:PEACEHEALTH
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439
Practice Address - Country:US
Practice Address - Phone:541-997-7134
Practice Address - Fax:541-902-1320
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550130NP NMNP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7102370000Medicaid
GA2025171Medicare ID - Type Unspecified
WV7102370000Medicaid