Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 60720095 | WA |
NPI | 1003353483 |
---|---|
Provider Name | Ana Bacic |
First Address | Edmonds, WA 98026-8012 |
Second Address | Edmonds, WA 98026-8012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |