Provider Demographics
NPI:1912941667
Name:MORAN, GAYLE MARGARET (ADULT NURSE PRACTITI)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:MARGARET
Last Name:MORAN
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:MARGARET
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:5100 SW MACADAM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6102
Mailing Address - Country:US
Mailing Address - Phone:971-202-5500
Mailing Address - Fax:971-202-5555
Practice Address - Street 1:5100 SW MACADAM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6102
Practice Address - Country:US
Practice Address - Phone:971-202-5500
Practice Address - Fax:971-202-5555
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR098006088N3 ANP-PP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287406Medicaid
ORGM01 067593003OtherBLUE CROSS/SHIELD PIN
OR287406Medicaid
ORP38120Medicare UPIN