Provider Demographics
NPI:1285094698
Name:HERRICK, GORDON A II (RN)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:A
Last Name:HERRICK
Suffix:II
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20706 61ST ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6137
Mailing Address - Country:US
Mailing Address - Phone:253-279-7919
Mailing Address - Fax:253-737-4437
Practice Address - Street 1:813 26TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7706
Practice Address - Country:US
Practice Address - Phone:253-279-7919
Practice Address - Fax:253-737-4437
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60400223163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse