Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | MD00048253 | WA |
NPI | 1689784043 |
---|---|
Provider Name | Dr. Coral D. Hanevold |
First Address | Seattle, WA 98105-3901 |
Second Address | Seattle, WA 98105-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 15/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B40158 | (02) | |
TL2833 | (05) | SC |