Basic Information
| Provider Information | |||||||||
| NPI: | 1538112719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERCEY | ||||||||
| FirstName: | GWENDOLYN | ||||||||
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| Credential: | A.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21911 76TH AVE W | ||||||||
| Address2: | #110 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256404950 | ||||||||
| FaxNumber: | 4256404958 | ||||||||
| Practice Location | |||||||||
| Address1: | 21911 76TH AVE W | ||||||||
| Address2: | #110 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256404950 | ||||||||
| FaxNumber: | 4256404958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/15/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | AP30001009 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | PI5218 | 01 | WA | REGENCE BLUE SHIELD | OTHER |