Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OP60752450 | WA |
NPI | 1003229113 |
---|---|
Provider Name | Brooke Elizabeth Parker |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2014 |
Last Update Date | 24/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003229113 | (05) | WA |