Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD00044804 | WA |
NPI | 1063401305 |
---|---|
Provider Name | Dr. Kerrie J. Spoonemore |
First Address | Seattle, WA 98105-4093 |
Second Address | Seattle, WA 98105-4093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8433757 | (05) | WA |
I36583 | (02) | WA |