Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00001259 | WA |
NPI | 1023284825 |
---|---|
Provider Name | Becky J Bly |
First Address | Spokane, WA 99208-4006 |
Second Address | Spokane, WA 99208-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2008 |
Last Update Date | 02/05/2008 |