Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 29891 | SC |
Y | 207PE0004X | Emergency Medical Services | MD60170287 | WA |
NPI | 1053511295 |
---|---|
Provider Name | Heather M Justice |
First Address | Arcadia, CA 91066-1448 |
Second Address | Tacoma, WA 98405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 02/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2031508 | (05) | WA |
298911 | (05) | SC |