Provider Demographics
NPI:1487740031
Name:SAKUMA, GAIL Y (ANP)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:Y
Last Name:SAKUMA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:SAKUMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:4115 SW IOWA STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221
Mailing Address - Country:US
Mailing Address - Phone:503-244-0564
Mailing Address - Fax:
Practice Address - Street 1:3710 SW US VETERANS HOSP. RD.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-273-5389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000028708N3 ANP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health