Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD60226658 | WA |
Y | 208600000X | Surgeon | MD60226658 | WA |
NPI | 1013051507 |
---|---|
Provider Name | Abigail K Wiebusch |
First Address | Seattle, WA 98101-2756 |
Second Address | Seattle, WA 98101-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 10/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013051507 | (05) | WA |
P01038754 | RAILROAD MEDICARE (01) | WA |