Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00005483 | WA |
NPI | 1063899896 |
---|---|
Provider Name | Cressa Hauge |
First Address | Bremerton, WA 98337-0212 |
Second Address | Bremerton, WA 98337-1420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2015 |
Last Update Date | 02/07/2015 |