Individual
MARY TOLLIVER GILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-PP
Contact information
Practice address
1111 NE 99TH AVENUE, PORTLAND, OR 97220
(503) 963-2707
(503) 963-2802
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
200450144NP ANP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269862
—
OR
05
—
9651860
—
WA
Enumeration date
07/26/2006
Last updated
09/13/2013
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