Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A82174 | CA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00048480 | WA |
N | 207YP0228X | Pediatric Otolaryngology | MD00048480 | WA |
NPI | 1750486874 |
---|---|
Provider Name | Carrie Ann Roller |
First Address | Spokane, WA 99210-2242 |
Second Address | Spokane, WA 99201-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 12/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1045537 | (05) | WA |
226035 | LABOR & INDUSTRIES (01) | WA |
H89921 | (02) | CA |
P000464176 | RAILROAD MEDICARE (01) | WA |