Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60074110 | WA |
NPI | 1003055492 |
---|---|
Provider Name | Brooke Gum |
First Address | Kennewick, WA 99336-2968 |
Second Address | Kennewick, WA 99336-2968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2009 |
Last Update Date | 06/10/2021 |