Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OP60674772 | WA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OP60674772 | WA |
NPI | 1790195436 |
---|---|
Provider Name | Janice M Gatzke |
First Address | Mount Vernon, WA 98274-4127 |
Second Address | Mount Vernon, WA 98274-4126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2014 |
Last Update Date | 27/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2037598 | (05) | WA |