Individual
KELLEE LOUISE GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15675 AMBAUM BLVD SW, BURIEN, WA 98166-2523
(206) 631-3011
Mailing address
15675 AMBAUM BLVD SW, BURIEN, WA 98166-2523
(206) 631-3011
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60733963
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP60733963
LPN
WA
Enumeration date
02/08/2019
Last updated
02/08/2019
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