Provider Demographics
NPI:1528217999
Name:GOULD, PAMELA LYNN (ND)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:GOULD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7385 HEALDSBURG AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:707-486-1964
Mailing Address - Fax:
Practice Address - Street 1:7385 HEALDSBURG AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-486-1964
Practice Address - Fax:707-847-2010
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-64175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath