Individual
GRETCHEN T WAMBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
565 EUREKA WAY, SEQUIM, WA 98382-5074
(360) 582-0808
(360) 683-5678
Mailing address
565 EUREKA WAY, SEQUIM, WA 98382-5074
(360) 582-0808
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10004382
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6999WA
REGENCE
WA
01
—
800016698
PREMERA BLUE CROSS
WA
01
—
80001669803
KPS
WA
05
—
8358285
—
WA
01
—
AB38563
MEDICARE ID
WA
Enumeration date
07/06/2006
Last updated
07/12/2011
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