Provider Demographics
NPI:1245599240
Name:MYERS, GILLIAN A (LMP)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:A
Last Name:MYERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 S 93RD ST APT B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-3071
Mailing Address - Country:US
Mailing Address - Phone:760-954-9321
Mailing Address - Fax:
Practice Address - Street 1:1833 S 93RD ST APT B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-3071
Practice Address - Country:US
Practice Address - Phone:760-954-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60222827246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other