Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 0401412076 | VA |
NPI | 1477517498 |
---|---|
Provider Name | Dr. Heather Ruth Olmo |
First Address | Tacoma, WA 98431-0001 |
Second Address | Tacoma, WA 98431-6101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 07/10/2019 |