Provider Demographics
NPI:1275190142
Name:ARTMAN, GWENDOLYN ANNE (BS, MS)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:ANNE
Last Name:ARTMAN
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6613 S FERDINAND ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-1104
Mailing Address - Country:US
Mailing Address - Phone:253-533-9361
Mailing Address - Fax:253-597-4178
Practice Address - Street 1:813 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4147
Practice Address - Country:US
Practice Address - Phone:253-533-9361
Practice Address - Fax:253-468-4737
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000000175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist