Provider Demographics
NPI:1538112719
Name:PIERCEY, GWENDOLYN (ARNP)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:PIERCEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21911 76TH AVE W
Mailing Address - Street 2:#110
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7903
Mailing Address - Country:US
Mailing Address - Phone:425-640-4950
Mailing Address - Fax:425-640-4958
Practice Address - Street 1:21911 76TH AVE W
Practice Address - Street 2:#110
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7903
Practice Address - Country:US
Practice Address - Phone:425-640-4950
Practice Address - Fax:425-640-4958
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001009363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPI5218OtherREGENCE BLUE SHIELD
WAS54563Medicare UPIN
WAAB03923Medicare ID - Type Unspecified