Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 60098656 | WA |
NPI | 1053079053 |
---|---|
Provider Name | Elizabeth Ann Simpson |
First Address | Port Angeles, WA 98362-9186 |
Second Address | Port Angeles, WA 98363-9472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2021 |
Last Update Date | 07/12/2021 |