1598102311 NPI number — MRS. MICAELA ASTER GAUSS CPM, LDM

Table of content: MRS. MICAELA ASTER GAUSS CPM, LDM (NPI 1598102311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598102311 NPI number — MRS. MICAELA ASTER GAUSS CPM, LDM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAUSS
Provider First Name:
MICAELA
Provider Middle Name:
ASTER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPM, LDM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVANS
Provider Other First Name:
MICAELA
Provider Other Middle Name:
ASTER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPM, LDM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598102311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 241
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97544-0241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-415-6036
Provider Business Mailing Address Fax Number:
541-833-5419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 MEADOWBROOK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97544-9503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-415-6036
Provider Business Practice Location Address Fax Number:
541-833-5419
Provider Enumeration Date:
06/03/2013

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: 176B00000X , with the licence number:  DEM-LD-10153125 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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