Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | 0101245367 | VA |
Y | 207RX0202X | Medical Oncology | MD60947927 | WA |
NPI | 1053401745 |
---|---|
Provider Name | Elizabeth Michelle Gunderson |
First Address | Newport News, VA 23601-1318 |
Second Address | Spokane Valley, WA 99216-1020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 15/01/2020 |