Provider Demographics
NPI:1043697469
Name:TAKACS, GYNINE
Entity Type:Individual
Prefix:
First Name:GYNINE
Middle Name:
Last Name:TAKACS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 142ND AVE SE
Mailing Address - Street 2:66
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-6607
Mailing Address - Country:US
Mailing Address - Phone:330-554-2507
Mailing Address - Fax:
Practice Address - Street 1:503 142ND AVE SE
Practice Address - Street 2:66
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-6607
Practice Address - Country:US
Practice Address - Phone:330-554-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician