Basic Information
| Provider Information | |||||||||
| NPI: | 1235293549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOSLEY | ||||||||
| FirstName: | GAYLE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2303 WOODED KNOLLS DR | ||||||||
| Address2: | |||||||||
| City: | PHILOMATH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419294218 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 N.E. 5TH ST | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034347462 | ||||||||
| FaxNumber: | 5034347335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 200050099NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 268960 | 01 | OR | OMAP (OREGON MEDICAL ASSI | OTHER |