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General NPI Number Information
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NPI Number | 1508881459
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Entity Type | Individual
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Provider Name | CONSTANCE E GAULTER M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 300 SIERRA COLLEGE DR STE 150
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5083
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Country | US
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Telephone | 530-802-6400
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Fax | 407-682-4844
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Provider Business Mailing Address
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Address Line | PO BOX 24132
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City | SEATTLE
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State | WA
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Zip | 98124-0132
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Country | US
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Telephone | 530-272-9770
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Fax | 530-802-6400
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G55765
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License Number State | CA
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