Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 32451 | IA |
NPI | 1659525541 |
---|---|
Provider Name | Dr. Gwendolyn Cheryl Ford |
First Address | Bremerton, WA 98312-1072 |
Second Address | Bremerton, WA 98312-1072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2008 |
Last Update Date | 05/11/2008 |