Provider Demographics
NPI:1326326992
Name:MCMURTREY INGELS, GWENDOLYN JEAN
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:JEAN
Last Name:MCMURTREY INGELS
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:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:VAUGHN
Mailing Address - State:WA
Mailing Address - Zip Code:98394-0143
Mailing Address - Country:US
Mailing Address - Phone:253-303-0239
Mailing Address - Fax:
Practice Address - Street 1:17011 S VAUGHN ROAD KPN
Practice Address - Street 2:
Practice Address - City:VAUGHN
Practice Address - State:WA
Practice Address - Zip Code:98394
Practice Address - Country:US
Practice Address - Phone:253-303-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA051868792Medicaid
WA200387647Medicaid