Provider Demographics
NPI:1144767732
Name:VERLEY, GINA MARIE (RNBSN)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:VERLEY
Suffix:
Gender:F
Credentials:RNBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97121-9716
Mailing Address - Country:US
Mailing Address - Phone:503-791-9609
Mailing Address - Fax:
Practice Address - Street 1:472 7TH AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:OR
Practice Address - Zip Code:97121-9716
Practice Address - Country:US
Practice Address - Phone:503-791-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081001855RN163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRA901C3OMedicaid