Provider Demographics
NPI:1477384816
Name:GALLARDO, GWENDOLYN DALE
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:DALE
Last Name:GALLARDO
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:PO BOX 6562
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98064-6562
Mailing Address - Country:US
Mailing Address - Phone:206-327-5492
Mailing Address - Fax:
Practice Address - Street 1:4710 S 302ND LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2950
Practice Address - Country:US
Practice Address - Phone:206-327-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide