Individual
BRYAN KEITH GAUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4200 6TH AVE SE STE 201, LACEY, WA 98503-1042
(360) 459-8311
Mailing address
PO BOX 1035, SILVER SPRINGS, NV 89429-1035
(859) 414-5917
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2029637
KY
Other
Enumeration date
11/22/2023
Last updated
11/22/2023
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