Provider Demographics
NPI:1588714695
Name:MILES, GRETCHEN (LMP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PINE AVE
Mailing Address - Street 2:STE. A102
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2599
Mailing Address - Country:US
Mailing Address - Phone:360-568-7075
Mailing Address - Fax:360-568-3205
Practice Address - Street 1:707 PINE AVE
Practice Address - Street 2:STE. A102
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2599
Practice Address - Country:US
Practice Address - Phone:360-568-7075
Practice Address - Fax:360-568-3205
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009289174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0834MIOtherREGENCE RIDER
WA0108974OtherWASHINGTON STATE L& I