Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD00040523 | WA |
NPI | 1174559686 |
---|---|
Provider Name | Ashley M Jerath Tatum |
First Address | Seattle, WA 98115-2024 |
Second Address | Seattle, WA 98115-2024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 03/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030005331 | RAIL ROAD MEDICARE (01) | WA |
7981JE | REGENCE (01) | WA |
8290835 | (05) | WA |
L78070 | (02) | WA |