is a Specialist in Port Angeles, Washington. practices all healthcare services and medical treatments related to Specialist. The NPI Number for is 1720030224. The last update date is .
's current location address is 902 Caroline St, Port Angeles, Washington. You can contact this provider via phone number 3604578578 and fax number 3604574841. The mailing address for is 902 Caroline St, Port Angeles, Washington. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 902 Caroline St, Port Angeles, Washington |
| Phone Number | 3604578578 |
| Fax Number | 3604574841 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1720030224 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 902 Caroline St |
|---|---|
| City | Port Angeles |
| State | Washington (WA) |
| Post Code | 983623910 |
| Phone Number | 3604578578 |
| Fax Number | 3604574841 |
Provider's Primary Taxonomy Detail
| Speciality | Specialist |
|---|---|
| Taxonomy | 174400000X |
| Licence No | MD00010877 |
|
Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 8166704 | WA | -- |
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