Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD00044096 | WA |
Y | 2084N0402X | Child Neurologist | MD00044096 | WA |
NPI | 1174604425 |
---|---|
Provider Name | Ednea A. Simon |
First Address | Seattle, WA 98122-5788 |
Second Address | Seattle, WA 98122-5788 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 09/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
246360 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8441875 | (05) | WA |
I46953 | (02) |