Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OP00001442 | WA |
N | 208200000X | Surgeon | OP00001442 | WA |
N | 208600000X | Surgeon | OP00001442 | WA |
NPI | 1225028459 |
---|---|
Provider Name | Dr. Sheila Carolyn Lally |
First Address | Poulsbo, WA 98370-6664 |
Second Address | Poulsbo, WA 98370-6664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 26/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1089317 | (05) | WA |
E80868 | (02) | WA |