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General NPI Number Information
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NPI Number | 1265221402
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Entity Type | Individual
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Provider Name | CHADY GLADYS WOLLOR LPN
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Gender | Female
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 9720 S TACOMA WAY
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City | LAKEWOOD
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State | WA
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Zip | 98499-4456
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Country | US
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Telephone | 253-604-7422
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Fax | 253-302-8493
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Provider Business Mailing Address
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Address Line | 15435 COLES CT SE
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City | YELM
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State | WA
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Zip | 98597-7208
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Country | US
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Telephone | 612-384-2432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 61562214
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License Number State | WA
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