Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | O-0622 | ID |
N | 207YS0123X | Facial Plastic Surgeon | O-0622 | ID |
NPI | 1467667550 |
---|---|
Provider Name | Dr. Brandy Marie Tacia |
First Address | Post Falls, ID 83854-5326 |
Second Address | Post Falls, ID 83854-5275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 02/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1467667550 | (05) | ID |
2013695 | (05) | WA |