Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 036-11163 | IL |
Y | 2084N0402X | Child Neurologist | MD60793408 | WA |
NPI | 1063471159 |
---|---|
Provider Name | Dr. Mark Stephen Wainwright |
First Address | Seattle, WA 98105-3901 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036111633 | (05) | IL |
1063471159 | (05) | WA |
I25032 | (02) | IL |