Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD60877066 | WA |
Y | 111NI0900X | Internist | MD60877066 | WA |
NPI | 1003278706 |
---|---|
Provider Name | Emily J. Grossniklaus |
First Address | Seattle, WA 98195-0001 |
Second Address | Seattle, WA 98195-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003278706 | (05) | WA |