Provider Demographics
NPI:1336839786
Name:GATES, MIKAELA C (RNFA)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:C
Last Name:GATES
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11786 SW BARNES RD STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5926
Mailing Address - Country:US
Mailing Address - Phone:503-924-2323
Mailing Address - Fax:503-601-0569
Practice Address - Street 1:11786 SW BARNES RD STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5926
Practice Address - Country:US
Practice Address - Phone:503-924-2323
Practice Address - Fax:503-601-0569
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201806815RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant