Individual
COURTNEY SHAE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
364 SE 8TH AVE STE 108A, HILLSBORO, OR 97123-4253
(503) 640-3687
(503) 640-3688
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
092344-23
NH
363L00000X
Nurse Practitioner
AP141935
TX
363LF0000X
Family Nurse Practitioner
Primary
10024300-APRN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401436702
—
TX
05
—
401436703
—
TX
Enumeration date
07/05/2019
Last updated
06/13/2024
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