Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP61203370 | WA |
NPI | 1003582362 |
---|---|
Provider Name | Hannah Collier Goettle |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-5795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003582362 | (05) | WA |