1063711711 NPI number — NORA GEDGAUDAS

Table of content: NORA GEDGAUDAS (NPI 1063711711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063711711 NPI number — NORA GEDGAUDAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEDGAUDAS
Provider First Name:
NORA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063711711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 NORTH WEST JOHNSON STREET
Provider Second Line Business Mailing Address:
SUITE #123
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-274-7733
Provider Business Mailing Address Fax Number:
503-274-7770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 NW JOHNSON ST
Provider Second Line Business Practice Location Address:
SUITE #123
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97209-1325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-274-7733
Provider Business Practice Location Address Fax Number:
503-274-7770
Provider Enumeration Date:
03/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X , with the licence number:  000400 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 133N00000X . This is a "NUTRITIONIST" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com