Provider Demographics
NPI:1265163331
Name:GORMAN, MEGHAN KINSELLA
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KINSELLA
Last Name:GORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SE 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3306
Mailing Address - Country:US
Mailing Address - Phone:503-805-3289
Mailing Address - Fax:
Practice Address - Street 1:1600 SE 51ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3306
Practice Address - Country:US
Practice Address - Phone:503-805-3289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program