Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1083213649 |
---|---|
Provider Name | Dr. Charissa Bausch |
First Address | Vancouver, WA 98663-2240 |
Second Address | Vancouver, WA 98663-2240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2020 |
Last Update Date | 27/01/2022 |