Provider Demographics
NPI:1811530215
Name:GIDEON, ELAINE MARIE
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARIE
Last Name:GIDEON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:MARIE
Other - Last Name:GIDEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6303 95TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-8512
Mailing Address - Country:US
Mailing Address - Phone:360-791-6850
Mailing Address - Fax:
Practice Address - Street 1:6303 95TH AVE SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-8512
Practice Address - Country:US
Practice Address - Phone:360-943-4962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider