Healthcare Provider Details

I. General information

NPI: 1972760973
Provider Name (Legal Business Name): ANN JANELLE GOETCHEUS GEHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 PACIFIC AVE STE. 300
TACOMA WA
98402-4443
US

IV. Provider business mailing address

1708 E 44TH ST
TACOMA WA
98404-4611
US

V. Phone/Fax

Practice location:
  • Phone: 253-597-4550
  • Fax: 253-597-4556
Mailing address:
  • Phone: 253-471-4553
  • Fax: 253-474-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD037558
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: