Individual
GISELE RENEE ROHDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAP, PA-C
Contact information
Practice address
1040 NW 22ND AVE STE 560, PORTLAND, OR 97210
(503) 413-5525
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
21635
CA
363A00000X
Physician Assistant
Primary
PA192781
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB235501
MEDICARE ID
CA
Enumeration date
09/13/2011
Last updated
10/28/2020
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