Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00006636 | WA |
NPI | 1013489335 |
---|---|
Provider Name | Agatha C. Stavnesli |
First Address | Seattle, WA 98124-3835 |
Second Address | Seattle, WA 98144-2730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2018 |
Last Update Date | 27/12/2018 |