Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD60076638 | WA |
N | 2084N0400X | Neurologist | MD60076638 | WA |
NPI | 1780666420 |
---|---|
Provider Name | Fuki Marie Hisama |
First Address | Seattle, WA 98145 |
Second Address | Seattle, WA 98195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 21/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0249609 | L&I (01) | WA |
1780666420 | (05) | WA |
F36302 | (02) |