Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MD0041231 | WA |
NPI | 1376509174 |
---|---|
Provider Name | Dr. Stella Desyatnikova |
First Address | Seattle, WA 98101-1720 |
Second Address | Seattle, WA 98101-1720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 30/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H67781 | (02) | WA |