Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH 60035140 | WA |
NPI | 1053563056 |
---|---|
Provider Name | Emily Rebecca Kelso |
First Address | Chehalis, WA 98532-2412 |
Second Address | Chehalis, WA 98532-2412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 02/11/2011 |