Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35.085390 | OH |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 60417743 | WA |
NPI | 1063757128 |
---|---|
Provider Name | Suzanne Gaudreault |
First Address | Tacoma, WA 98402-4400 |
Second Address | Tacoma, WA 98402-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2012 |
Last Update Date | 07/04/2021 |