Anzhelika Gavrilovich

Primary specialty

Gerontology Registered NurseTaxonomy code 163WG0600X

License

200941904RN Issued in OR

Practice address

4540 NE Glisan St
Portland, OR 97213-2333

Phone

(503) 215-3738

NPI assigned

Nov 23, 2016

Last updated

Nov 23, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Health System Oregon

  dba Providence Elder Place Portland

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1023098118
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479859200000",
    "number": "1720521784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132333",
            "telephone_number": "503-215-3738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVRILOVICH",
        "first_name": "ANZHELIKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-23",
        "last_updated": "2016-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "OR",
            "license": "200941904RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlyn Gavin
• Grace Olivia Gavin
• Terry Gavin, CRM
• Nathalia Andrea Gaviria-Correa, FNP
• Milton J Gavlick, MD
• Dmitriy V. Gavrilyuk, PHARM.D.
• Kathryn Gavula, PT
• Ed Gawer
• Adam Gawlak, LAC
• Rebecca Lynn Gawlista, O.M.H.A

• Gerontology Registered Nurse in Portland, OR
• Providers in Portland, OR by specialty
• Gerontology Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.