Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD60677480 | WA |
NPI | 1003172735 |
---|---|
Provider Name | Carolyn Kay |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Edmonds, WA 98026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2012 |
Last Update Date | 29/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003172735 | (05) | WA |