Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60589075 | WA |
NPI | 1063969533 |
---|---|
Provider Name | Brittany Anne Peschek |
First Address | Shelton, WA 98584 |
Second Address | Shelton, WA 98584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |