Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | MD61153930 | WA |
NPI | 1174751325 |
---|---|
Provider Name | Amy Beth Dettori |
First Address | Seattle, WA 98115-7502 |
Second Address | Oak Harbor, WA 98278-8800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 10/06/2021 |