Individual
MICHELLE LYNN GORTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
2500 W A ST, SUITE 201, MOSCOW, ID 83843-6000
(208) 883-2828
(208) 882-2179
Mailing address
2500 W A ST, SUITE 201, MOSCOW, ID 83843-6000
(208) 883-2828
(208) 882-2179
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
ST00003279
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ST00003279
LICENSE
WA
Enumeration date
07/28/2011
Last updated
07/28/2011
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