Basic Information
| Provider Information | |||||||||
| NPI: | 1659717171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERTSON | ||||||||
| FirstName: | SOFIA | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2051 KAEN RD | ||||||||
| Address2: | STE 367 | ||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970454035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037425300 | ||||||||
| FaxNumber: | 5037425979 | ||||||||
| Practice Location | |||||||||
| Address1: | 9775 SE SUNNYSIDE RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037943830 | ||||||||
| FaxNumber: | 5037943850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 200642274RN | OR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.