Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | PA60931075 | WA |
NPI | 1013578095 |
---|---|
Provider Name | Cecilia Christensen |
First Address | Steilacoom, WA 98388-1914 |
Second Address | Lacey, WA 98503-1038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2019 |
Last Update Date | 21/06/2019 |