Provider Demographics
NPI:1700417938
Name:SON, GABRIELLE ANN OGAN
Entity type:Individual
Prefix:
First Name:GABRIELLE ANN
Middle Name:OGAN
Last Name:SON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 ORIOLE LN NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4342
Mailing Address - Country:US
Mailing Address - Phone:360-556-9727
Mailing Address - Fax:
Practice Address - Street 1:2475 140TH AVE NE BLDG C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1892
Practice Address - Country:US
Practice Address - Phone:425-827-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WARN61208688163W00000X
WAAP61603038363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163W00000XNursing Service ProvidersRegistered Nurse