Goudelock, Penny
Goudelock, Penny is an individual health care provider with primary practice located at 1100 Pacific Ave Suite 202, Everett WA 98201-4261. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Goudelock, Penny can be contacted via phone (425) 388-4075.Contact Information
Primary practice address
1100 Pacific Ave Suite 202
Everett WA 98201-4261
Phone: (425) 388-4075
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA10005160 | Washington |
Profile Details
| NPI number | 1043433352 |
|---|---|
| LBN Legal business name | Goudelock, Penny |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 11th, 2007 |
| Last updated | Apr 14th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043433352 | NPPES |
| Washington | MEDICAID | 8485898 |
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