Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | AP30002151 | WA |
NPI | 1053437897 |
---|---|
Provider Name | Jo Gray |
First Address | Seattle, WA 98124-5653 |
Second Address | Bellevue, WA 98004-4623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 19/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8128084 | (05) | WA |
E13725 | (02) | WA |