Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP60234623 | WA |
NPI | 1003190331 |
---|---|
Provider Name | Katie L Gomez |
First Address | Spokane, WA 99205-6150 |
Second Address | Spokane, WA 99204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2011 |
Last Update Date | 23/03/2021 |