Provider Demographics
NPI:1326034125
Name:MEYER, GWENDOLYN J (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:J
Last Name:MEYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:GWENDOLYN
Other - Middle Name:J
Other - Last Name:WEINSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624-0258
Mailing Address - Country:US
Mailing Address - Phone:360-642-6350
Mailing Address - Fax:360-642-6309
Practice Address - Street 1:21 N VALLEY RD
Practice Address - Street 2:
Practice Address - City:NASELLE
Practice Address - State:WA
Practice Address - Zip Code:98638-8536
Practice Address - Country:US
Practice Address - Phone:360-484-7161
Practice Address - Fax:360-484-7178
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004334363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9631748Medicaid
WA176606OtherL & I
WA6671WEOtherBCBS
WA176606OtherL & I
WA6671WEOtherBCBS