Healthcare Provider Details

I. General information

NPI: 1437805082
Provider Name (Legal Business Name): CHIMENE GUMBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 S STEVENS ST APT 3
TACOMA WA
98409-1628
US

IV. Provider business mailing address

6451 S STEVENS ST APT 3
TACOMA WA
98409-1628
US

V. Phone/Fax

Practice location:
  • Phone: 253-342-8004
  • Fax:
Mailing address:
  • Phone: 253-342-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61190886
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: