Provider Information for 1134882632
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PATRICIA GORDON
Sex: Female
NPI: 1134882632
Last Updated: 2021-10-21
Certification Date: 2021-09-23
Certification Date: 2021-09-23
Details
| Name | Value | ||||||||||||
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| NPI | 1134882632 | ||||||||||||
| Enumeration Date | 2021-10-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 5002 TACOMA, WA 98415-0002 United States Phone: 206-755-6264 | Fax: | ||||||||||||
| Primary Practice Address | 1220 MLK JR. WAY #5002 TACOMA, WA 98415 United States Phone: 206-755-6264 | Fax: | ||||||||||||
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