Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN 60543708 | WA |
NPI | 1841644119 |
---|---|
Provider Name | Ina Apanasevich |
First Address | Puyallup, WA 98375-6963 |
Second Address | Puyallup, WA 98375-6963 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2016 |
Last Update Date | 22/04/2016 |