Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD61049309 | WA |
NPI | 1003329566 |
---|---|
Provider Name | Dr. Hayley Meek Heesemann |
First Address | Moses Lake, WA 98837-1872 |
Second Address | Moses Lake, WA 98837-4620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2017 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2168420 | (05) | WA |