Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH60104727 | WA |
NPI | 1063867935 |
---|---|
Provider Name | Farrah Jumawan Azur |
First Address | Tacoma, WA 98402-4488 |
Second Address | Tacoma, WA 98402-4488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2016 |
Last Update Date | 28/04/2016 |