Basic Information
| Provider Information | |||||||||
| NPI: | 1467758581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERSOON-GUNDY | ||||||||
| FirstName: | JO | ||||||||
| MiddleName: | NADINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FLEMING | ||||||||
| OtherFirstName: | JO | ||||||||
| OtherMiddleName: | NADINE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 421 | ||||||||
| Address2: | |||||||||
| City: | LIBERTY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990190421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094746842 | ||||||||
| FaxNumber: | 5092277070 | ||||||||
| Practice Location | |||||||||
| Address1: | 316 W BOONE AVE | ||||||||
| Address2: | SUITE 757 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992012354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098680876 | ||||||||
| FaxNumber: | 5093850670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2011 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A115156 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD60428318 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD60428318 | WA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.