Provider Demographics
NPI:1497511760
Name:GILMAN, MARISA IRENE (DNP, CNM, ARNP)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:IRENE
Last Name:GILMAN
Suffix:
Gender:F
Credentials:DNP, CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 SW BOXWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4220
Mailing Address - Country:US
Mailing Address - Phone:503-382-9108
Mailing Address - Fax:
Practice Address - Street 1:1608 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1448
Practice Address - Country:US
Practice Address - Phone:503-233-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202212292RN163WM0102X
OR10033269363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn