Healthcare Provider Details

I. General information

NPI: 1013134345
Provider Name (Legal Business Name): JESSICA EVELYN GOW-LEE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 CHALAN SAN ANTONIO
TAMUNING GU
96913-3605
US

IV. Provider business mailing address

388 YPAO RD
TAMUNING GU
96913-3701
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-8881
  • Fax: 671-648-2548
Mailing address:
  • Phone: 671-646-8881
  • Fax: 671-648-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60417258
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number100601
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP30002337
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: