Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH000 02843 | WA |
NPI | 1962596528 |
---|---|
Provider Name | Dale Anthony Elmenhurst |
First Address | Walla Walla, WA 99362-3326 |
Second Address | Walla Walla, WA 99362-3326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 28/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U41935 | (02) | WA |