Provider Demographics
NPI:1316488620
Name:SIM LE, GLORIA (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:SIM LE
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SW DISK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3754
Mailing Address - Country:US
Mailing Address - Phone:541-293-1325
Mailing Address - Fax:510-379-9209
Practice Address - Street 1:1001 SW DISK DR STE 250
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3754
Practice Address - Country:US
Practice Address - Phone:541-293-1325
Practice Address - Fax:541-229-1314
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202109330RN163W00000X
OR202109331NP-PP363LF0000X, 363LP0808X
CA95006055363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily