Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | RN60415133 | WA |
NPI | 1609471242 |
---|---|
Provider Name | Angela Gum |
First Address | Everett, WA 98203-2132 |
Second Address | Everett, WA 98203-2132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2020 |
Last Update Date | 17/02/2021 |