Individual
GINA LYNN WALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2310
(360) 414-2048
(360) 575-6749
Mailing address
PO BOX 249, LONGVIEW, WA 98632-7154
(360) 414-2048
(360) 575-6749
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN00170658
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0223024
LABOR & INDUSTRIES
WA
01
—
8944886
CRIME VICTIMS
WA
05
—
9653361
—
WA
01
—
AP30007691
WA ARNP LICENSE
WA
01
—
RN00170658
WA RN LICENSE
WA
01
—
RN597396
RN LICENSE #
CA
Enumeration date
04/06/2007
Last updated
11/14/2007
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