Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI60220931 | WA |
N | 222Z00000X | Podiatrist | OI60220931 | WA |
Y | 224P00000X | Prosthetist | PS60220933 | WA |
NPI | 1093310575 |
---|---|
Provider Name | Alexandra M Gates |
First Address | Beaverton, OR 97008-7111 |
Second Address | Spokane Valley, WA 99216-6017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2020 |
Last Update Date | 02/12/2020 |