Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 181132-1205 | UT |
NPI | 1235119587 |
---|---|
Provider Name | Dr. Kelly J Faucette |
First Address | Puyallup, WA 98375-6238 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 09/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD-000 | (02) |