Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 42547 | WA |
N | 2080A0000X | Adolescent Medicine | 42547 | WA |
NPI | 1053356303 |
---|---|
Provider Name | Anne H Reese |
First Address | Shoreline, WA 98177 |
Second Address | Shoreline, WA 98177 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 29/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8361925 | (05) | WA |