Healthcare Provider Details

I. General information

NPI: 1205586369
Provider Name (Legal Business Name): MARY EMLYN GWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 HARRY HINES BLVD
DALLAS TX
75235-7709
US

IV. Provider business mailing address

17659 NE 128TH PL
REDMOND WA
98052-1149
US

V. Phone/Fax

Practice location:
  • Phone: 214-590-8000
  • Fax:
Mailing address:
  • Phone: 425-495-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: