Basic Information
Provider Information
NPI: 1730158478
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAUTHIER
FirstName: VERLENE
MiddleName: JOYCE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 34876
Address2:  
City: SEATTLE
State: WA
PostalCode: 981241876
CountryCode: US
TelephoneNumber: 4256565412
FaxNumber: 4256564096
Practice Location
Address1: 27005 168TH PL SE
Address2: STE 301
City: COVINGTON
State: WA
PostalCode: 980424902
CountryCode: US
TelephoneNumber: 2533951971
FaxNumber: 2533951983
Other Information
ProviderEnumerationDate: 03/15/2006
LastUpdateDate: 09/19/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RR0500XMD00023841WAY Allopathic & Osteopathic PhysiciansInternal MedicineRheumatology

No ID Information.


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