Provider Demographics
NPI:1972072890
Name:GONTHIER, GARY DEAN (RN)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:DEAN
Last Name:GONTHIER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 BOYER AVE APT I2
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2366
Mailing Address - Country:US
Mailing Address - Phone:206-795-7599
Mailing Address - Fax:
Practice Address - Street 1:602 BOYER AVE APT I2
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2366
Practice Address - Country:US
Practice Address - Phone:206-795-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60862383163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse