Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 5101018064 | MI |
Y | 207T00000X | Neurosurgeon | OP60625254 | WA |
NPI | 1073828794 |
---|---|
Provider Name | Dr. Lee Sandquist |
First Address | Wenatchee, WA 98801-2028 |
Second Address | Wenatchee, WA 98801-2028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2010 |
Last Update Date | 23/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073828794 | (05) | WA |
P01633798 | RR PTAN WVH (01) | WA |