Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD60804832 | WA |
NPI | 1164712931 |
---|---|
Provider Name | Dr. Daiva Nevidomskyte |
First Address | Tacoma, WA 98405-5304 |
Second Address | Tacoma, WA 98405-5304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2018866 | (05) | WA |