Provider Demographics
NPI:1609051739
Name:GIMMESON, LINDA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:GIMMESON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:CONNELL
Mailing Address - State:WA
Mailing Address - Zip Code:99326-9716
Mailing Address - Country:US
Mailing Address - Phone:509-234-0777
Mailing Address - Fax:
Practice Address - Street 1:5060 PARADISE RD
Practice Address - Street 2:
Practice Address - City:CONNELL
Practice Address - State:WA
Practice Address - Zip Code:99326-9716
Practice Address - Country:US
Practice Address - Phone:509-234-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021075174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist