Provider Demographics
NPI:1740560523
Name:GORKOS, JOAN F (LMP)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:F
Last Name:GORKOS
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 1:18424 73RD AVE NE UNIT MAIN
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-3710
Mailing Address - Country:US
Mailing Address - Phone:206-877-3932
Mailing Address - Fax:
Practice Address - Street 1:18424 73RD AVE NE UNIT MAIN
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-3710
Practice Address - Country:US
Practice Address - Phone:206-877-3932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60239975174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist