Basic Information
| Provider Information | |||||||||
| NPI: | 1003059882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILMORE | ||||||||
| FirstName: | NANIS | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 NE 20TH AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032336940 | ||||||||
| FaxNumber: | 5032362676 | ||||||||
| Practice Location | |||||||||
| Address1: | 541 NE 20TH AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032336940 | ||||||||
| FaxNumber: | 5032362676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2009 | ||||||||
| LastUpdateDate: | 04/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | 081001531RN | OR | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.