Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH60774708 | WA |
NPI | 1063934644 |
---|---|
Provider Name | Cici Hannah Kamphaus |
First Address | Wenatchee, WA 98801-2800 |
Second Address | Wenatchee, WA 98801-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2017 |
Last Update Date | 19/12/2018 |