Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP60805173 | WA |
NPI | 1003327784 |
---|---|
Provider Name | Callie Rose Adams |
First Address | Liberty Lake, WA 99019-0331 |
Second Address | Spokane, WA 99204-2339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2017 |
Last Update Date | 07/11/2017 |