Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW00000264 | WA |
NPI | 1083753644 |
---|---|
Provider Name | Ms. Amy Nicole Gordon |
First Address | Tacoma, WA 98403-1934 |
Second Address | Tacoma, WA 98406-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |