Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 201391241NP-PP | OR |
NPI | 1134428378 |
---|---|
Provider Name | Dr. Andreana Marie-Concetta Gentile |
First Address | Portland, OR 97239-3519 |
Second Address | Milwaukie, OR 97267-4960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2011 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500661333 | (05) | OR |