Basic Information
| Provider Information | |||||||||
| NPI: | 1609851534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HITCHCOCK | ||||||||
| FirstName: | GAVIN | ||||||||
| MiddleName: | O'HARA | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APRN, FNP, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9040 JACKSON AVENUE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984310001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9040 JACKSON AVENUE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682235 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 482242, 11412 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207L00000X | AP60796420 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.