Provider Demographics
NPI:1861040362
Name:GAUL, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:GAUL
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 1:945 GOETHALS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3552
Mailing Address - Country:US
Mailing Address - Phone:509-392-5220
Mailing Address - Fax:509-946-0455
Practice Address - Street 1:945 GOETHALS DR STE 300
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3552
Practice Address - Country:US
Practice Address - Phone:509-392-5220
Practice Address - Fax:509-946-0455
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2168496Medicaid