Provider Demographics
NPI:1336958107
Name:GILLESPIE, LAURENCE EDWARD
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:EDWARD
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:JOYCE
Mailing Address - State:WA
Mailing Address - Zip Code:98343-0140
Mailing Address - Country:US
Mailing Address - Phone:360-775-5958
Mailing Address - Fax:
Practice Address - Street 1:364 SASQUATCH LANE
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363
Practice Address - Country:US
Practice Address - Phone:360-775-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider