Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP61037398 | WA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP61037398 | WA |
NPI | 1295209369 |
---|---|
Provider Name | Abigael Bethany Whitaker |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2019 |
Last Update Date | 25/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1295209369 | (05) | WA |