Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD00032564 | WA |
NPI | 1033169511 |
---|---|
Provider Name | Elizabeth Mary Vennos |
First Address | Bellingham, WA 98226 |
Second Address | Bellingham, WA 98226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 14/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G07704 | (02) |