Healthcare Provider Details

I. General information

NPI: 1336131119
Provider Name (Legal Business Name): GWYNNETH G. NEACE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 SOUTH THIRD STREET
DAYTON WA
99328
US

IV. Provider business mailing address

1012 SOUTH THIRD STREET
DAYTON WA
99328
US

V. Phone/Fax

Practice location:
  • Phone: 509-382-3200
  • Fax: 509-382-2748
Mailing address:
  • Phone: 509-382-3200
  • Fax: 509-382-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP00000784
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: