Individual
GWENDOLYN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
14711 38TH DR SE, MILL CREEK, WA 98012-4282
(360) 220-1360
Mailing address
14711 38TH DR SE, MILL CREEK, WA 98012-4282
(360) 220-1360
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP00045623
WA
Other
Enumeration date
12/12/2023
Last updated
12/12/2023
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